Delays in discharge in a tertiary care pediatric hospital

Rajendu Srivastava, Bryan L. Stone, Raza Patel, Matthew Swenson, Andrew Davies, Christopher G. Maloney, Paul C. Young, Brent C. James

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND: Delays in discharges affect both efficiency and timeliness of care; 2 measures of quality of inpatient care. OBJECTIVE: Describe number, length, and type of delays in hospital discharges. Characterize impact of delays on overall length of stay (LOS) and costs. DESIGN: Prospective observational cohort study. SETTING: Tertiary-care children's hospital. PATIENTS: All children on 2 medical teams during August 2004. INTERVENTION: Two research assistants presented detailed data of patient care (from daily rounds) to 2 physicians who identified delays and classified the delay type. Discharge was identified as delayed if there was no medical reason for the patient to be in the hospital on a given day. MEASUREMENTS: Delays were classified using a validated and reliable instrument, the Delay Tool. LOS and costs were extracted from an administrative database. RESULTS: Two teams cared for 171 patients. Mean LOS and costs were 7.3 days (standard deviation [SD] 14.3) and $15,197 (SD 38,395), respectively: 22.8% of patients experienced at least 1 delay, accounting for 82 delay-related hospital days (9% of total hospital days) and $170,000 in costs (8.9% of hospital costs); 42.3% of the delays resulted from physician behavior, 21.8% were related to discharge planning, 14.1% were related to consultation, and 12.8% were related to test scheduling. CONCLUSIONS: Almost one-fourth of patients in this 1-month period could have been discharged sooner than they were. Impact of delays on LOS and costs are substantial. Interventions will need to address variations in physician criteria for discharge, more efficient discharge planning, and timely scheduling of consultation and diagnostic testing.

Original languageEnglish (US)
Pages (from-to)481-485
Number of pages5
JournalJournal of hospital medicine
Volume4
Issue number8
DOIs
StatePublished - Oct 1 2009

Fingerprint

Pediatric Hospitals
Tertiary Healthcare
Length of Stay
Costs and Cost Analysis
Patient Discharge
Physicians
Referral and Consultation
Hospital Costs
Quality of Health Care
Observational Studies
Inpatients
Patient Care
Cohort Studies
Databases
Research

Keywords

  • Children's hospital
  • Delays in discharge
  • Pediatrics

ASJC Scopus subject areas

  • Leadership and Management
  • Internal Medicine
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Srivastava, R., Stone, B. L., Patel, R., Swenson, M., Davies, A., Maloney, C. G., ... James, B. C. (2009). Delays in discharge in a tertiary care pediatric hospital. Journal of hospital medicine, 4(8), 481-485. https://doi.org/10.1002/jhm.490

Delays in discharge in a tertiary care pediatric hospital. / Srivastava, Rajendu; Stone, Bryan L.; Patel, Raza; Swenson, Matthew; Davies, Andrew; Maloney, Christopher G.; Young, Paul C.; James, Brent C.

In: Journal of hospital medicine, Vol. 4, No. 8, 01.10.2009, p. 481-485.

Research output: Contribution to journalArticle

Srivastava, R, Stone, BL, Patel, R, Swenson, M, Davies, A, Maloney, CG, Young, PC & James, BC 2009, 'Delays in discharge in a tertiary care pediatric hospital', Journal of hospital medicine, vol. 4, no. 8, pp. 481-485. https://doi.org/10.1002/jhm.490
Srivastava R, Stone BL, Patel R, Swenson M, Davies A, Maloney CG et al. Delays in discharge in a tertiary care pediatric hospital. Journal of hospital medicine. 2009 Oct 1;4(8):481-485. https://doi.org/10.1002/jhm.490
Srivastava, Rajendu ; Stone, Bryan L. ; Patel, Raza ; Swenson, Matthew ; Davies, Andrew ; Maloney, Christopher G. ; Young, Paul C. ; James, Brent C. / Delays in discharge in a tertiary care pediatric hospital. In: Journal of hospital medicine. 2009 ; Vol. 4, No. 8. pp. 481-485.
@article{1c1797d87bbc4a3487683144ce0ab8dc,
title = "Delays in discharge in a tertiary care pediatric hospital",
abstract = "BACKGROUND: Delays in discharges affect both efficiency and timeliness of care; 2 measures of quality of inpatient care. OBJECTIVE: Describe number, length, and type of delays in hospital discharges. Characterize impact of delays on overall length of stay (LOS) and costs. DESIGN: Prospective observational cohort study. SETTING: Tertiary-care children's hospital. PATIENTS: All children on 2 medical teams during August 2004. INTERVENTION: Two research assistants presented detailed data of patient care (from daily rounds) to 2 physicians who identified delays and classified the delay type. Discharge was identified as delayed if there was no medical reason for the patient to be in the hospital on a given day. MEASUREMENTS: Delays were classified using a validated and reliable instrument, the Delay Tool. LOS and costs were extracted from an administrative database. RESULTS: Two teams cared for 171 patients. Mean LOS and costs were 7.3 days (standard deviation [SD] 14.3) and $15,197 (SD 38,395), respectively: 22.8{\%} of patients experienced at least 1 delay, accounting for 82 delay-related hospital days (9{\%} of total hospital days) and $170,000 in costs (8.9{\%} of hospital costs); 42.3{\%} of the delays resulted from physician behavior, 21.8{\%} were related to discharge planning, 14.1{\%} were related to consultation, and 12.8{\%} were related to test scheduling. CONCLUSIONS: Almost one-fourth of patients in this 1-month period could have been discharged sooner than they were. Impact of delays on LOS and costs are substantial. Interventions will need to address variations in physician criteria for discharge, more efficient discharge planning, and timely scheduling of consultation and diagnostic testing.",
keywords = "Children's hospital, Delays in discharge, Pediatrics",
author = "Rajendu Srivastava and Stone, {Bryan L.} and Raza Patel and Matthew Swenson and Andrew Davies and Maloney, {Christopher G.} and Young, {Paul C.} and James, {Brent C.}",
year = "2009",
month = "10",
day = "1",
doi = "10.1002/jhm.490",
language = "English (US)",
volume = "4",
pages = "481--485",
journal = "Journal of hospital medicine (Online)",
issn = "1553-5606",
publisher = "John Wiley and Sons Inc.",
number = "8",

}

TY - JOUR

T1 - Delays in discharge in a tertiary care pediatric hospital

AU - Srivastava, Rajendu

AU - Stone, Bryan L.

AU - Patel, Raza

AU - Swenson, Matthew

AU - Davies, Andrew

AU - Maloney, Christopher G.

AU - Young, Paul C.

AU - James, Brent C.

PY - 2009/10/1

Y1 - 2009/10/1

N2 - BACKGROUND: Delays in discharges affect both efficiency and timeliness of care; 2 measures of quality of inpatient care. OBJECTIVE: Describe number, length, and type of delays in hospital discharges. Characterize impact of delays on overall length of stay (LOS) and costs. DESIGN: Prospective observational cohort study. SETTING: Tertiary-care children's hospital. PATIENTS: All children on 2 medical teams during August 2004. INTERVENTION: Two research assistants presented detailed data of patient care (from daily rounds) to 2 physicians who identified delays and classified the delay type. Discharge was identified as delayed if there was no medical reason for the patient to be in the hospital on a given day. MEASUREMENTS: Delays were classified using a validated and reliable instrument, the Delay Tool. LOS and costs were extracted from an administrative database. RESULTS: Two teams cared for 171 patients. Mean LOS and costs were 7.3 days (standard deviation [SD] 14.3) and $15,197 (SD 38,395), respectively: 22.8% of patients experienced at least 1 delay, accounting for 82 delay-related hospital days (9% of total hospital days) and $170,000 in costs (8.9% of hospital costs); 42.3% of the delays resulted from physician behavior, 21.8% were related to discharge planning, 14.1% were related to consultation, and 12.8% were related to test scheduling. CONCLUSIONS: Almost one-fourth of patients in this 1-month period could have been discharged sooner than they were. Impact of delays on LOS and costs are substantial. Interventions will need to address variations in physician criteria for discharge, more efficient discharge planning, and timely scheduling of consultation and diagnostic testing.

AB - BACKGROUND: Delays in discharges affect both efficiency and timeliness of care; 2 measures of quality of inpatient care. OBJECTIVE: Describe number, length, and type of delays in hospital discharges. Characterize impact of delays on overall length of stay (LOS) and costs. DESIGN: Prospective observational cohort study. SETTING: Tertiary-care children's hospital. PATIENTS: All children on 2 medical teams during August 2004. INTERVENTION: Two research assistants presented detailed data of patient care (from daily rounds) to 2 physicians who identified delays and classified the delay type. Discharge was identified as delayed if there was no medical reason for the patient to be in the hospital on a given day. MEASUREMENTS: Delays were classified using a validated and reliable instrument, the Delay Tool. LOS and costs were extracted from an administrative database. RESULTS: Two teams cared for 171 patients. Mean LOS and costs were 7.3 days (standard deviation [SD] 14.3) and $15,197 (SD 38,395), respectively: 22.8% of patients experienced at least 1 delay, accounting for 82 delay-related hospital days (9% of total hospital days) and $170,000 in costs (8.9% of hospital costs); 42.3% of the delays resulted from physician behavior, 21.8% were related to discharge planning, 14.1% were related to consultation, and 12.8% were related to test scheduling. CONCLUSIONS: Almost one-fourth of patients in this 1-month period could have been discharged sooner than they were. Impact of delays on LOS and costs are substantial. Interventions will need to address variations in physician criteria for discharge, more efficient discharge planning, and timely scheduling of consultation and diagnostic testing.

KW - Children's hospital

KW - Delays in discharge

KW - Pediatrics

UR - http://www.scopus.com/inward/record.url?scp=70449699716&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70449699716&partnerID=8YFLogxK

U2 - 10.1002/jhm.490

DO - 10.1002/jhm.490

M3 - Article

C2 - 19824097

AN - SCOPUS:70449699716

VL - 4

SP - 481

EP - 485

JO - Journal of hospital medicine (Online)

JF - Journal of hospital medicine (Online)

SN - 1553-5606

IS - 8

ER -