Unnecessary Hospital Days in an Academic Medical Center: A Survey of Hospitalists and Discharge Planners

1University of Michigan Health System, Ann Arbor, Ml
2University of Michigan Health System, Ann Arbor, Ml
3University of Michigan Health System, Ann Arbor, Ml
4University of Michigan Health System, Ann Arbor, Ml
5University of Michigan Health System, Ann Arbor, Ml
6University of Michigan Health System, Ann Arbor, Ml
7University of Michigan Health System, Ann Arbor, Ml

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 55

Background:

Medically “unnecessary” hospital days pose a great concern to patients, payers, hospitals, and care providers. Increasing length of stay from delays increases costs and potentially nosocomial complications. Hospitalists at our academic medical center (AMC) manage nearly 10,000 patients annually as supervising physicians on resident teams (RTs) and on 'faculty hospitalist” teams (FHTs), without residents. As part of an institutional goal to reduce length of stay, we sought to determine the frequency and the most common reasons for excess hospital days. We also compared the rate of excess hospital days between resident and faculty hospitalist services.

Methods:

We developed an online survey to prospectively collect data (day of the week, patient census, number of patients experiencing an “unnecessary” hospital day, and the primary reason for that delay). After demonstrating the Web survey, hospitalists and discharge planners were sent daily reminders encouraging them to independently complete the survey over a 2‐month period.

Results:

We collected data on 3574 patient‐days from the hospitalists (1632 from RTs and 1942 from FHTs) and 2502 patient‐days from the discharge planners. Among all the hospitalists' responses, 395 patient‐days (11%) were believed to be delayed — the RTs 171 patient‐days (10.5%) versus the FHTs 224 patient‐days (11.5%). There was no difference between the 2 groups (P = 0.32). The discharge planners believed that 186 of the patient‐days (7.4%) were delayed, a substantially smaller perceived number of delays when compared with the hospital‐ists' responses (P < 0.01). The hospitalists believed that the most common reason for discharge delay was “extended‐care facility (ECF) not available” (111 bed days, 28.1%), followed by “patients and/or family not prepared for discharge” (62 days, 15.7%), “procedure related” (62 days, 15.7%), and “test scheduling related” (52 days, 13.2%). The discharge planners agreed with these classifications.

Conclusions:

More than 1 in 10 hospital days was believed to be unnecessary at this AMC. Major causes included lack of ECF availability, patient/family‐related reasons, procedure related, and test scheduling related. Resident services do not face any greater number of significant delays to discharge than do hospitalist‐run services at our AMC. Our results projected over a year suggest a significant number of unnecessary bed days that could potentially be better utilized to help the patient population that we serve.

Author Disclosure:

C. Kim, none; A. Hart, none; R. Paretti, none; L. Kuhn, none; A. Dowling, none; J. Benkesar, none; D. Spahlinger, none.

To cite this abstract:

Kim C, Hart A, Paretti R, Kuhn L, Dowling A, Benke‐ser J, Spahlinger D. Unnecessary Hospital Days in an Academic Medical Center: A Survey of Hospitalists and Discharge Planners. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 55. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/unnecessary-hospital-days-in-an-academic-medical-center-a-survey-of-hospitalists-and-discharge-planners/. Accessed May 26, 2019.

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