Study probes barriers to hospital discharges

Average days spent in hospital after being medically ready to go is 20

Older patients in particular are affected by barriers that prevent them from being discharged from the hospital, even after they have been medically cleared to leave.

That’s according to a recently released study from the Foundation for Healthy Communities, which found that the barriers – which don’t only affect older patients – can lead to expensive delays to providing the right care in the right place.

Many barriers to timely discharges were found throughout New Hampshire, said Shawn LaFrance, executive director of the foundation and author of the study, but the most frequently cited was the inability to access a skilled nursing home bed. LaFrance said the lack of a nursing home beds affected 61 percent of the patients in the survey.

The study identified 516 people who were medically cleared to leave the hospital but unable to do so during a three-month period (Nov. 1, 2014 through Jan. 31, 2015) in 21 of the 26 acute care hospitals in New Hampshire.

The study found that 57 percent of those surveyed were 65 or older, while 32 percent were ages 45-64 years old.

Major barriers to a timely discharge, identified as a percentage of the total number of patients, in the study were:
• Unable to access a nursing home bed: 61 percent
• Uninsured, under-insured or waiting for Medicaid to determine eligibility: 27.5 percent
• No advance directives or waiting for guardianship process: 14 percent
• Unable to afford in-home assistance: 14 percent
• Mental health/psychiatric care needs: 13 percent

The average number of additional days that a person spent in the hospital after being medically ready for discharge was 20 days, according to the study. There were 58 people, or 11 percent, who experienced delays of over 50 days.

The 516 people in the study stayed a total of 10,277 additional patient days in the hospital while no longer needing acute care services and generated additional costs of approximately $27.2 million in acute care hospital expenditures for people with non-acute care needs, the study found.

“Improving health care and reducing costs requires a systems approach since there are different points in the health care continuum where barriers to being in the best place can limit a person’s independence and their overall well-being,” LaFrance said.

He said the information was collected to inform policymakers about the barriers that patients encounter and identify strategies to eliminate barriers to a timely hospital discharge.

To read the entire report, visit healthynh.com.