Skip to main content

All Access Subscription

Get unlimited access to our full publication and article library.

Get Access Now

Interested in Group Sales? Learn more

Discharge Orders

Data Indicate Hospital Stays Are Longer, Causing Discharge Delays

By Jonathan Springston, Editor, Relias Media

The average length of hospital stay is up 19% overall in 2022 compared to 2019, according to recently released data from the American Hospital Association (AHA). These percentages are even higher for patients awaiting discharge to post-acute providers, skilled nursing facilities, and psychiatric hospitals.

The longer patients wait to move on to the next step of their care, the more likely it is they could experience a negative outcome. Additionally, medical facilities already facing staff and budget limitations have to expend even more resources to accommodate the additional time.

Notably, hospitals do not receive reimbursement for this extra spending on unplanned stays. In October, the AHA sent a letter to Congress asking lawmakers to consider a series of general and targeted solutions, including a temporary per diem Medicare payment mechanism.

"Delays in patient discharges create bottlenecks in the healthcare system, adding to the already overwhelming challenges facing our hospitals and caregivers. Temporary relief to overburdened hospitals and other providers will help ensure patients get the most appropriate care and will relieve stress on frontline healthcare workers,” said AHA President Rick Pollack after the release of the length of stay data last week.

Relias Media reporting throughout 2022 suggests problems with discharges are multifold, systemic, and predate COVID-19. In emergency departments (EDs), where many patients often initially engage with the healthcare system for their treatment, frontline providers might board people in the department because there are no available inpatient beds upstairs in the hospital.

While waiting in this limbo, some patients choose to leave without seeing anyone. Long waits and leaving without treatment put patients at risk and expose facilities to legal liability.

Meanwhile, in those occupied beds, some patients are simply refusing discharge, as reported in the May 2022 issue of Hospital Case Management. These patients might be living with mental/behavioral health issues or facing social determinants of health obstacles. Forcibly discharging patients is a safety risk and ethically murky.

The pandemic exacerbated the discharge problem, along with the cascading fallout of staff shortages, supply chain disruptions, and rising costs. Sadly, there are no standard solutions for discharge delays. Each facility handles boarding and overstays differently.

A North Carolina-based health system created a discharge waiting lobby that has helped shorten the time to discharge patients and frees beds for those waiting in the ED. Since the program started, the discharge order time to actual discharge was shortened from more than three hours to two hours and 20 minutes.

Another tactic is using estimated date of discharge (EDD) analytics. In the June 2022 issue of Hospital Case Management, author Jeni Miller wrote, “as a frame of reference for rounds, the EDD can ground discussions for the clinical team and help them consciously think about the length of stay for that patient. The information also can be used to predict census and capacity, especially when a powerful data program provides a clear report of aggregate data.”

Miller interviewed a source who expounded further. “Once the date is in the computer, the hospital case managers can leverage the information as a census and throughput tool. … The capacity center or transfer center [can look] at compiled data and can know whether they’re short 20 beds or in an ‘out of capacity’ crisis. The data can also be used as a predictor for future capacity planning.”

For more on this and related subjects, be sure to read the latest issues of ED Management and Healthcare Risk Management.