Cai Christopher, Lindquist Karla, Bongiovanni Tasce
School of Medicine, University of California San Francisco, San Francisco, California, USA.
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA.
Trauma Surg Acute Care Open. 2020 Nov 9;5(1):e000535. doi: 10.1136/tsaco-2020-000535. eCollection 2020.
Discharge delays for non-medical reasons put patients at unnecessary risk for hospital-acquired infections, lead to loss of revenue for hospitals and reduce hospital capacity to treat other patients. The objective of this study was to determine prevalence of, and patient characteristics associated with, delays in discharge at an urban county trauma service.
We performed a retrospective cohort study with data from Zuckerberg San Francisco General Hospital (ZSFGH), a level-1 trauma center and safety net hospital in San Francisco, California. The study included 1720 patients from the trauma surgery service at ZSFGH. A 'delay in discharge' was defined as days in the hospital, including an initial overnight stay, after all medical needs had been met. We used logistic and zero-inflated negative binomial regression models to test whether the following factors were associated with prolonged, non-medical length of stay: age, gender, race/ethnicity, housing, disposition location, type of insurance, having a primary care provider, primary language and zip code.
Of the 1720 patients, 15% experienced a delay in discharge, for a total of 1147 days (median 1.5 days/patient). The following were statistically significant (p<0.05) predictors of delays in discharge in a multivariable logistic regression model: older age, unhoused status or disposition to home health or postacute care (compared with home discharge) were associated with increased likelihood of delays. Having private insurance or Medicare (compared with public insurance) and discharge against medical advice or absent without leave (compared with home discharge) were associated with reduced likelihood of delays in discharge after all medical needs were met.
These results suggest that policymakers interested in reducing non-medical hospital stays should focus on addressing structural determinants of health, such as lack of housing, bottlenecks at postacute care disposition destinations and lack of adequate insurance.
Epidemiological, Level III.
非医疗原因导致的出院延迟会使患者面临医院获得性感染的不必要风险，导致医院收入损失，并降低医院治疗其他患者的能力。本研究的目的是确定城市县创伤服务中出院延迟的患病率以及与之相关的患者特征。
我们进行了一项回顾性队列研究，使用了来自加利福尼亚州旧金山的一级创伤中心和安全网医院扎克伯格旧金山总医院（ZSFGH）的数据。该研究包括ZSFGH创伤外科服务的1720名患者。“出院延迟”定义为在所有医疗需求得到满足后在医院住院的天数，包括最初的过夜停留。我们使用逻辑回归和零膨胀负二项回归模型来测试以下因素是否与延长的非医疗住院时间相关：年龄、性别、种族/族裔、住房、处置地点、保险类型、是否有初级保健提供者、主要语言和邮政编码。
在1720名患者中，15%经历了出院延迟，总计1147天（中位数为每位患者1.5天）。在多变量逻辑回归模型中，以下因素是出院延迟的统计学显著（p<0.05）预测因素：年龄较大、无家可归状态或转至家庭健康或急性后期护理（与出院回家相比）与延迟可能性增加相关。拥有私人保险或医疗保险（与公共保险相比）以及违反医疗建议出院或擅自离院（与出院回家相比）与所有医疗需求得到满足后出院延迟的可能性降低相关。
这些结果表明，对减少非医疗住院时间感兴趣的政策制定者应专注于解决健康的结构性决定因素，如住房不足、急性后期护理处置目的地的瓶颈以及缺乏足够的保险。
流行病学，三级。
