Shaikh Sajid A, Robinson Richard D, Cheeti Radhika, Rath Shyamanand, Cowden Chad D, Rosinia Frank, Zenarosa Nestor R, Wang Hao
Department of Information Technology, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
BMC Health Serv Res. 2018 Jan 30;18(1):59. doi: 10.1186/s12913-018-2879-2.
Prolonged hospital discharge boarding can impact patient flow resulting in upstream Emergency Department crowding. We aim to determine the risks predicting prolonged hospital discharge boarding and their direct and indirect effects on patient flow.
Retrospective review of a single hospital discharge database was conducted. Variables including type of disposition, disposition boarding time, case management consultation, discharge medications prescriptions, severity of illness, and patient homeless status were analyzed in a multivariate logistic regression model. Hospital charges, potential savings of hospital bed hours, and whether detailed discharge instructions provided adequate explanations to patients were also analyzed.
A total of 11,527 admissions was entered into final analysis. The median discharge boarding time was approximately 2 h. Adjusted Odds Ratio (AOR) of patients transferring to other hospitals was 7.45 (95% CI 5.35-10.37), to court or law enforcement custody was 2.51 (95% CI 1.84-3.42), and to a skilled nursing facility was 2.48 (95% CI 2.10-2.93). AOR was 0.57 (95% CI 0.47-0.71) if the disposition order was placed during normal office hours (0800-1700). AOR of early case management consultation was 1.52 (95% CI 1.37-1.68) versus 1.73 (95% CI 1.03-2.89) for late consultation. Eighty-eight percent of patients experiencing discharge boarding times within 2 h of disposition expressed positive responses when questioned about the quality of explanations of discharge instructions and follow-up plans based on satisfaction surveys. Similar results (86% positive response) were noted among patients whose discharge boarding times were prolonged (> 2 h, p = 0.44). An average charge of $6/bed/h was noted in all hospital discharges. Maximizing early discharge boarding (≤ 2 h) would have resulted in 16,376 hospital bed hours saved thereby averting $98,256.00 in unnecessary dwell time charges in this study population alone.
Type of disposition, case management timely consultation, and disposition to discharge dwell time affect boarding and patient flow in a tertiary acute care hospital. Efficiency of the discharge process did not affect patient satisfaction relative to the perceived quality of discharge instruction and follow-up plan explanations. Prolonged disposition to discharge intervals result in unnecessary hospital bed occupancy thereby negatively impacting hospital finances while delivering no direct benefit to patients.
长时间的出院待床会影响患者流转，导致上游急诊科拥挤。我们旨在确定预测出院待床时间延长的风险因素及其对患者流转的直接和间接影响。
对单一医院出院数据库进行回顾性分析。在多因素逻辑回归模型中分析了包括出院处置类型、待床时间、病例管理会诊、出院用药处方、疾病严重程度和患者无家可归状态等变量。还分析了医院费用、潜在节省的病床小时数，以及详细的出院指导是否向患者提供了充分解释。
最终纳入分析的共有11527例住院病例。出院待床时间中位数约为2小时。转至其他医院患者的调整优势比（AOR）为7.45（95%置信区间5.35 - 10.37），转至法院或执法机构监护的为2.51（95%置信区间1.84 - 3.42），转至专业护理机构的为2.48（95%置信区间2.10 - 2.93）。如果出院处置指令在正常办公时间（08:00 - 17:00）下达，AOR为0.57（95%置信区间0.47 - 0.71）。早期病例管理会诊的AOR为1.52（95%置信区间1.37 - 1.68），晚期会诊的为1.73（95%置信区间1.03 - 2.89）。根据满意度调查，88%在出院处置后2小时内待床的患者在被问及出院指导和后续计划的解释质量时给出了积极回应。出院待床时间延长（>2小时）的患者中也有类似结果（86%积极回应，p = 0.44）。所有出院病例平均每床每小时收费6美元。仅在本研究人群中，将早期出院待床时间最大化（≤2小时）可节省16376个病床小时，从而避免98256.00美元的不必要停留时间费用。
出院处置类型、病例管理及时会诊以及出院待床时间会影响三级急性护理医院的待床情况和患者流转。相对于出院指导和后续计划解释的感知质量，出院流程的效率并未影响患者满意度。延长出院处置间隔会导致不必要的病床占用，从而对医院财务产生负面影响，同时对患者没有直接益处。
