There are a number of barriers that can cause a patient’s discharge from the hospital to be delayed. These barriers extend the length of stay of a patient. While some barriers require clinical resolution, others can be acted upon. Identifying these barriers can help reduce the length of stay of a patient.
Reducing excess length of stay is important for both health systems and patients. It can lead to higher costs for health systems and an extended hospital stay also may increase the odds of a patient contracting a hospital-acquired illness. Reducing LOS can improve throughput and increase capacity for hospitals, including beds and staff time, enabling the hospital to serve more patients.
Identifying the barriers that can prolong a patient’s hospital stay doesn’t have to be difficult or time consuming. Through machine learning and natural language processing technologies, the length of stay worklist in Pieces Predict reviews all clinical documentation and uses existing data from the electronic health record (EHR) to surface potential discharge barriers in real time and helps identify on whom to focus first. Pieces Predict’s reLOS module identifies and prioritizes actionable bottlenecks that may create barriers for patients being discharged in a timely manner.
There are many barriers that can prolong a patient’s hospital stay, so we’ve compiled a list of some of the diverse types of barriers to hospital discharge that AI can surface:
Abuse and violence
A patient may be exposed to or a victim of physical or mental abuse or neglect.
Behavioral health issues
A patient may be facing behavioral health issues such as suicidal or homicidal thoughts, a psychiatric crisis, social isolation, or stress.
This is a category where multiple, diverse and potentially interacting clinical issues together are creating complexity that will delay discharge.
Awaiting a consultation from a specific service provider, such as PT or OT can add time to the hospitalization.
A patient may have challenges with basic necessities like shelter, utilities, food, or medical care causing a delay in hospital discharge, if not addressed early in the hospital stay.
Guardianship and family barriers
A patient may lack the ability to make decisions for themselves and require a guardian to make decisions for them. If a patient lacks this decision maker, their hospital stay will be prolonged.
If a patient is currently on IV medications, they may need them post-discharge causing a potential delay in hospital discharge if not arranged.
There may be issues that arise surrounding a patient's insurance, such as prior authorization, out of network issues, medication coverage, or immigration status, that can impact a patient’s length of stay.
Pending test or procedure
A physician may be waiting on a pending lab test, procedure, or result for a patient.
Post acute needs
Some patients may require a longer hospital stay because they have an unsafe discharge location or require post discharge placement in another facility.
Post-discharge care coordination
A patient may be in need of post-discharge care coordination. They might have transportation needs, require durable medical equipment (DME) post discharge, or post discharge follow-ups.
Some patients may require restraints or a hospital sitter.
Social determinants of health such as economic stability, food insecurity, literacy, family support, or housing may cause a patient’s discharge from the hospital to be delayed.
Specific clinical intervention
This is an example of a highly specific clinical barrier or intervention. In this case, a patient may have a chest tube in place that needs removal or may require the placement of one.
A patient may be NPO, consuming nothing by mouth, or on a liquid diet.
A patient may have a history of substance misuse, addiction, or extraneous drug use.
A patient may have a catheter requiring removal before being discharged from the hospital.
This is a sampling of the types of barriers which can delay a hospital discharge. AI technologies that can read the patient record and other sources to identify this in real-time can help multidisciplinary teams prioritize their work to the most critical issues that could delay a discharge.