Elderly likely to be hospitalised longer than necessary

Single patients, those from non-English speaking backgrounds (NESB) and the elderly are the most likely to experience issues to be kept in hospital longer than necessary, a new study has found.

The article appears in the new edition of the Australian Health Review, the peer reviewed journal of the Australian Healthcare and Hospitals Association, released 8 August.

“Delayed discharge is a major issue in hospitals because it leads to unanticipated length of stay and bed block. This can compromise both the quality and cost-effectiveness of care,” researcher, Ms Lixin Ou said.

“In the Australian context, delayed discharge is a major reason for the unavailability of beds in major acute care hospitals. Recent studies suggest a range of reasons for discharge delays. Generically, the reasons for discharge delay include medical issues, hospital factors, patient and carer needs, and issues related to accessing alternative care or social care.

“The more detailed reasons include complication of the patient medical condition, delay in receiving diagnostic services or results of investigations, transfer delays, a lack of rehabilitation places, awaiting home care, community packages or community services and patient-related factors.

“This study examined the data collected from a quality-improvement project aiming to improve the discharge process via a dedicated discharge facilitator. We found that the patients’ medical condition, consultation delays, diagnostic service delays and awaiting allied health were the most common reasons for discharge delay.

“Almost one third of patient discharges were delayed by their medical problems. The awaiting rehabilitation placement and awaiting for respite care categories were not as common but were significantly higher within the population aged 65 years or older.

“Specific policies may need to be developed to solve these problems, including developing intermediate care provision and designing specific databases in order to facilitate information flow within the hospital and between the residential care facilities and acute care hospitals.

“Although the overall proportion of patients experiencing delayed transfer to an acute care hospital was low, patients from a NESB were significantly less likely to have this experience but more likely to have a medical problem as the reason for delayed discharge.

“While the evidence is not clear, we may speculate that these patients may have more communication problems with health professionals regarding their symptoms, complications or other ailments that may lead to delayed identification or treatment. However, it is also possible that more patients from an NESB were referred for discharge planning based on their medical problems.

“A significantly higher proportion of patients who were single, widowed or divorced had problems of delayed consultation, lack of social support, were awaiting respite care, and experienced a delayed transfer to an acute care hospital.

“Providing these groups of patients with specific attention and assistance in order to foster social support, improve communication and facilitate access to respite care should reduce delayed discharge and assist in maximising the use of scarce hospital resources,” Ms Ou said.