Adecuación de los ingresos y estancias en un Servicio de Medicina Interna de un hospital de segundo nivel utilizando la versión concurrente del AEP (Appropriateness Evaluation Protocol)

Delayed Hospital Discharges of Older Patients: A Systematic Review on Prevalence and Costs

PURPOSE OF THE STUDY

To determine the prevalence of delayed discharges of elderly inpatients and associated costs.

DESIGN AND METHODS

We searched Medline, Embase, Global Health, CAB Abstracts, Econlit, Web of Knowledge, EBSCO - CINAHL, The Cochrane Library, Health Management Information Consortium, and SCIE - Social Care Online for evidence published between 1990 and 2015 on number of days or proportion of delayed discharges for elderly inpatients in acute hospitals. Descriptive and regression analyses were conducted. Data on proportions of delayed discharges were pooled using a random effects logistic model and the association of relevant factors was assessed. Mean costs of delayed discharge were calculated in USD adjusted for Purchasing Power Parity (PPP).

RESULTS

Of 64 studies included, 52 (81.3%) reported delayed discharges as proportions of total hospital stay and 9 (14.1%) estimated the respective costs for these delays. Proportions of delayed discharges varied widely, from 1.6% to 91.3% with a weighted mean of 22.8%. This variation was also seen in studies from the same country, for example, in the United Kingdom, they ranged between 1.6% and 60.0%. No factor was found to be significantly associated with delays. The mean costs of delayed discharge also varied widely (between 142 and 31,935 USD PPP adjusted), reflecting the variability in mean days of delay per patient.

IMPLICATIONS

Delayed discharges occur in most countries and the associated costs are significant. However, the variability in prevalence of delayed discharges and available data on costs limit our knowledge of the full impact of delayed discharges. A standardization of methods is necessary to allow comparisons to be made, and additional studies are required-preferably by disease area-to determine the postdischarge needs of specific patient groups and the estimated costs of delays.

[Barber and Johnson diagram and latent reserve as tools to optimise the management of hospital beds]

INTRODUCTION

The measurement, evaluation and analysis of the bed resources are functions of the Admission and Clinical Documentation Department and are a challenge for the management of acute hospital admissions.The aim of the present study was to analyse the management of bed resources using the Barber and Johnson Diagram (B&J) and latent reserve, during epidemiological contingencies in the Hospital Universitario Río Hortega.

MATERIALS AND METHODS

A retrospective review was carried out on hospital admission indicators, from 2008 to February 2017, using the B&J diagram as a graphic tool to compare length of stay, replacement interval, turnover rate, monthly and annual occupancy rate for the hospital and services.The latent and manifest reserve was calculated.

RESULTS

The B&J diagram showed differences in occupancy rate and provision of functional beds between the years reviewed and the approaches used. A lower provision of beds and higher length of stay corresponded with an increase in occupancy, decrease in replacement interval, and increase in turnover rate. The latent reserve showed that, between a discharge and a new entry into the same bed, 14 inappropriately occupied beds could be available.

CONCLUSIONS

The review of the hospital admission indicators, their integration into the B&J diagram, and use of latent reserve could be included in the hospital information system and benefit the decision-making in the operational management of beds.