The costs of nonclinical delayed discharge in a tertiary care clinic in Colombia

Abstract

Objective: to describe the sociodemographic and clinical characteristics of patients with nonclinical delayed discharge and estimate the resulting costs in a tertiary healthcare facility from June 1 to August 31, 2017.

Materials and methods: a retrospective observational study. The working definition of delayed discharge was patients who, from a clinical perspective, could be discharged but who continued to occupy a bed due to nonclinical problems. The data were taken from the medical charts, and the total costs incurred by the inappropriate length of stay were used for the cost analysis, including the cost per inpatient day, supplies, medications and medical assessments, from the payer´s cost perspective.

Results: of the 3,273 discharges during the study period, there were 79 cases of delayed discharge (2.4%). The mean age of the patients was 49 years. Sixty-two percent had subsidized medical insurance; 60.7% came from other departments or distant towns. The total number of inpatient days lost due to this cause was 547, with a me of 6.6 days per patient. The departments which were most affected were internal medicine and palliative care. The main causes were: the need for tickets to return to their place of origin, early discharge due to medications or discharge supplies and the need for oxygen. The total cost incurred due to delayed discharge was USD 83,935, with an average of USD 1,062.47 per patient.

Conclusion: delayed discharge is an evident healthcare problem. The main causes found in this study were social and regional transport issues. Delayed discharge also causes a significant additional expense in material and financial resources for both the institutions and the system