The discharge of a patient from the hospital can often be a complex process. There are many components that go into releasing a patient from the hospital, and there may often be barriers that could extend the length of a patient’s hospital stay. A discharge barrier is an obstacle, clinical or otherwise, that delays a patient’s safe discharge from the hospital. There are many common hospital discharge barriers that are important to be aware of such as likelihood for readmission, hospital resources, patient readiness, communication, unaddressed social determinants of health (SDOH) or having an unsafe discharge location.
What is “Excess Length of Stay” and why is it important?
Questions often center around the average length of stay of patients, but this metric, while important, does not take into account the case mix or condition severity of a hospital’s patients. A “long” length of stay should not be frowned upon if it was clinically necessary!
It is more meaningful to focus on excess length of stay (LOS), which reflects unnecessary or avoidable days of a hospital stay that may reflect a LOS that extends beyond the time a patient should have been clinically ready for discharge. By comparing the actual length of stay to the benchmark LOS for the conditions that were treated, a more fair assessment can be made regarding the efficiency of the care. External factors, such as SDOH or complex post-discharge placement, are often a cause of excess LOS. Identifying and addressing these issues in a timely manner can ensure that patients are personally and logistically ready to be discharged once they are deemed clinically ready.
Likelihood for readmission
The likelihood of a patient being readmitted to the hospital is an important factor taken into consideration during hospital discharge planning. If a patient shows signs that he or she is likely to be readmitted to the hospital, this will prolong their stay. Identifying and predicting factors that are a likely cause for readmission is important to a patient’s care journey. Some factors that are considered in likelihood for readmission include age, marital status, prior admission, number of past ED visits, existing health complications and social determinants of health, such as housing status, health illiteracy, food insecurity, lack of family or social support, etc.
Both the availability and allocation of hospital resources can impact the hospital discharge process and extend a patient's length of stay. Not having access to the necessary resources to complete a patient’s discharge from the hospital can complicate the process for case managers. If the right resources are available, the ease of their accessibility and location within the hospital is also an important thing to keep in mind with the planning of the hospital discharge process.
The readiness of a patient or the patient’s family is a barrier to hospital discharge that can be more difficult to control or predict than other barriers. If a patient unexpectedly decides they are not ready to leave the hospital or their family expresses concerns about the timing of their discharge, this can extend the patient’s stay and make it more difficult for case managers to complete the hospital discharge process.
Successful communication is a key factor that influences the hospital discharge process. Both communication between hospital staff and communication between the patient and their doctor is crucial. Sometimes a patient might withhold information from their nurse or doctor until plans for discharge have already begun. There also may be information included in doctors notes that is not being utilized fully due to the vast amount of information present in said notes.
Unsafe discharge location
A patient’s discharge location upon leaving the hospital is an important factor that is considered by case managers. If a patient is homeless additional planning is needed to release the individual to a safe location, such as a homeless shelter. A safe discharge location is necessary because it helps ensure that the patient has access to resources that will encourage their wellness outside of hospital walls.
How to assist case managers in discharge planning
Being able to more easily and effectively identify barriers to discharge is important to a patient’s care journey. Artificial intelligence (AI) is becoming increasingly important to health systems and the case managers that work for them. AI is an amazing tool that can help case managers to identify and predict discharge barriers, which also allows them to better plan for these barriers. Pieces Predict is a cloud-based software that uses AI and natural language process (NLP) to extract actionable data from the electronic medical record (EHR). Extracting this data is important in enabling doctors, nurses, and case managers to work more efficiently and give them insights that can improve the hospital discharge process.
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