Centre for Health Economics, University of York, York, UK.
Social Policy Research Unit, University of York, York, UK.
Age Ageing. 2021 Jun 28;50(4):1073-1076. doi: 10.1093/ageing/afab035.
Delayed transfers of care (DTOC), often unhelpfully referred to as 'bed blocking', has become a byword for waste and inefficiency in healthcare systems throughout the world. An estimated 2.7 million bed days are occupied each year in England by older people no longer in need of acute treatment, estimated to cost £820 million (2014/15) in inpatient care. Policy and media attention have often been drawn to this narrative of financial waste, resulting in policy setting that directly targets the level of DTOC, but has done little to put patient health first. These figures and policies portray a misleading image of the delays as primarily of concern in terms of their financial burden on acute hospital care, with little consideration given to the quantification on patient health or wider societal impacts. In spite of the multi-factorial decision-making process that occurs for each patient discharge, current evaluation frameworks and national policy setting fail to reflect the complexity of the process. In this commentary, we interrogate the current approach to the quantification of the DTOC impact and explore how policies and evaluation methods can do more to reflect the true impact of the delays.
延迟转院（DTOC），常被无益地称为“病床阻塞”，已成为世界各地医疗体系中浪费和效率低下的代名词。据估计，英格兰每年有 270 万张病床被不再需要急性治疗的老年人占用，估计在住院护理方面花费了 8.2 亿英镑（2014/15 年）。政策和媒体的关注经常集中在这种财务浪费的叙述上，导致政策直接针对 DTOC 的水平，但几乎没有考虑将患者的健康放在首位。这些数字和政策描绘了一个误导性的形象，即这些延迟主要是因为它们对急性医院护理的财务负担的担忧，而很少考虑到患者健康或更广泛的社会影响的量化。尽管每个患者出院的决策过程都是多因素的，但当前的评估框架和国家政策制定未能反映出这一过程的复杂性。在这篇评论中，我们对 DTOC 影响的量化方法进行了探讨，并探讨了政策和评估方法如何更好地反映延迟的真实影响。
