Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study

• Published in: BMC health services research Vol. 19; no. 1; p. 935
• Main Authors: Bai, Anthony D, Dai, Cathy, Srivastava, Siddhartha, Smith, Christopher A, Gill, Sudeep S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.12.2019; BioMed Central; BMC
• Subjects: Academic Medical Centers - economics; Aged; Aged, 80 and over; Canada; Clinical Decision Rules; Clinical prediction rule; Cohort analysis; Comorbidity; Comparative analysis; Cross Infection - epidemiology; Delayed discharge; Delirium; Dementia; Economic aspects; Female; General internal medicine; Health aspects; Health services; Hospital admission and discharge; Hospital Costs; Hospital patients; Hospitalization; Hospitalization - economics; Humans; Internal Medicine; Length of stay; Length of Stay - economics; Logistic Models; Long term health care; Male; Medical centers; Medical research; Middle Aged; Mortality; Nosocomial infections; Nursing homes; Patient Care Management - economics; Patient Discharge; Patient safety; Physical therapy; Pressure ulcers; Regression analysis; Retirement homes; Retrospective Studies; Risk Factors; Tertiary Care Centers - economics; Variables; Canada; Clinical prediction rule; Delayed discharge; General internal medicine
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-019-4760-3

Hospitalized patients are designated alternate level of care (ALC) when they no longer require hospitalization but discharge is delayed while they await alternate disposition or living arrangements. We assessed hospital costs and complications for general internal medicine (GIM) inpatients who had delayed discharge. In addition, we developed a clinical prediction rule to identify patients at risk for delayed discharge. We conducted a retrospective cohort study of consecutive GIM patients admitted between 1 January 2015 and 1 January 2016 at a large tertiary care hospital in Canada. We compared hospital costs and complications between ALC and non-ALC patients. We derived a clinical prediction rule for ALC designation using a logistic regression model and validated its diagnostic properties. Of 4311 GIM admissions, 255 (6%) patients were designated ALC. Compared to non-ALC patients, ALC patients had longer median length of stay (30.85 vs. 3.95 days p < 0.0001), higher median hospital costs ($22,459 vs. $5003 p < 0.0001) and more complications in hospital (25.5% vs. 5.3% p < 0.0001) especially nosocomial infections (14.1% vs. 1.9% p < 0.0001). Sensitivity analyses using propensity score and pair matching yielded similar results. In a derivation cohort, seven significant risk factors for ALC were identified including age > =80 years, female sex, dementia, diabetes with complications as well as referrals to physiotherapy, occupational therapy and speech language pathology. A clinical prediction rule that assigned each of these predictors 1 point had likelihood ratios for ALC designation of 0.07, 0.25, 0.66, 1.48, 6.07, 17.13 and 21.85 for patients with 0, 1, 2, 3, 4, 5, and 6 points respectively in the validation cohort. Delayed discharge is associated with higher hospital costs and complication rates especially nosocomial infections. A clinical prediction rule can identify patients at risk for delayed discharge.