Excess hospitalization days in an academic medical center: perceptions of hospitalists and discharge planners.

OBJECTIVE

To determine the frequency of and reasons for medically unnecessary hospital days.

STUDY DESIGN

Prospective observational cohort study.

METHODS

We developed an online survey to prospectively collect data on hospitalists' and discharge planners' perceived delays in treatment or discharge for patients on their general medicine services. Over a 2-month period, hospitalists and discharge planners completed a daily online survey.

RESULTS

We collected data on 3574 patient-days from our hospitalists and data on 2502 patient-days from our discharge planners. Among the hospitalists' responses, 395 patient-days (11%) were thought to be unnecessary. Among the discharge planners' responses, only 186 patient-days (7%) were thought to be unnecessary. The hospitalists believed that the most common reason for discharge delay was lack of extended care facility availability (111 patient-days [28%]), followed by patient or family reasons (62 patient-days [15%]), procedure delays (62 patient-days [15%]), and test scheduling delays (52 patient-days [13%]). The discharge planners' data were similar.

CONCLUSIONS

More than 10% of hospital days were reported by our hospitalists to be unnecessary at this academic medical center. Major reasons were lack of extended care facility availability, patient or family reasons, procedure delays, and test scheduling delays. A simple survey instrument to assess perceived delays in the hospital may provide real-time information to initiate improvement changes to reduce excess hospitalization days.