Risks predicting prolonged hospital discharge boarding in a regional acute care hospital

Sajid A. Shaikh, Richard D. Robinson, Radhika Cheeti, Shyamanand Rath, Chad D. Cowden, Francis Rosinia, Nestor R. Zenarosa, Hao Wang

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Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish
Article number59
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
StatePublished - 30 Jan 2018

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Case Management
Referral and Consultation
Patient Discharge
Odds Ratio
Bed Occupancy
Logistic Models
Skilled Nursing Facilities
Time Management
Hospital Charges
Law Enforcement
Crowding
Tertiary Healthcare
Patient Satisfaction
Prescriptions
Hospital Emergency Service
Databases
Population

Keywords

  • Boarding time
  • Consultation
  • Disposition
  • Hospital discharge

Cite this

Shaikh, S. A., Robinson, R. D., Cheeti, R., Rath, S., Cowden, C. D., Rosinia, F., ... Wang, H. (2018). Risks predicting prolonged hospital discharge boarding in a regional acute care hospital. BMC Health Services Research, 18(1), [59]. https://doi.org/10.1186/s12913-018-2879-2
Shaikh, Sajid A. ; Robinson, Richard D. ; Cheeti, Radhika ; Rath, Shyamanand ; Cowden, Chad D. ; Rosinia, Francis ; Zenarosa, Nestor R. ; Wang, Hao. / Risks predicting prolonged hospital discharge boarding in a regional acute care hospital. In: BMC Health Services Research. 2018 ; Vol. 18, No. 1.
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abstract = "Background: 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. Methods: 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. Results: 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. Conclusion: 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.",
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Shaikh, SA, Robinson, RD, Cheeti, R, Rath, S, Cowden, CD, Rosinia, F, Zenarosa, NR & Wang, H 2018, 'Risks predicting prolonged hospital discharge boarding in a regional acute care hospital', BMC Health Services Research, vol. 18, no. 1, 59. https://doi.org/10.1186/s12913-018-2879-2

Risks predicting prolonged hospital discharge boarding in a regional acute care hospital. / Shaikh, Sajid A.; Robinson, Richard D.; Cheeti, Radhika; Rath, Shyamanand; Cowden, Chad D.; Rosinia, Francis; Zenarosa, Nestor R.; Wang, Hao.

In: BMC Health Services Research, Vol. 18, No. 1, 59, 30.01.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Risks predicting prolonged hospital discharge boarding in a regional acute care hospital

AU - Shaikh, Sajid A.

AU - Robinson, Richard D.

AU - Cheeti, Radhika

AU - Rath, Shyamanand

AU - Cowden, Chad D.

AU - Rosinia, Francis

AU - Zenarosa, Nestor R.

AU - Wang, Hao

PY - 2018/1/30

Y1 - 2018/1/30

N2 - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

AB - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

KW - Boarding time

KW - Consultation

KW - Disposition

KW - Hospital discharge

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U2 - 10.1186/s12913-018-2879-2

DO - 10.1186/s12913-018-2879-2

M3 - Article

VL - 18

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

M1 - 59

ER -