Impact of bed blockers on hospital costs and assessment of obstacles to discharge. Prospective study in four Belgian hospitals

Abstract

Introduction: Hospitals regularly observe that the length of stay of some patients is extended although their presence is no longer justified by medical reasons. The lack of non-hospital facilities that can accommodate patients after hospitalization can have a significant impact on hospital costs. The objective of the study is to establish the profiles of bed blockers, to identify the obstacles to their discharge, the need for adequate facilities after hospitalization, to calculate the length of delay, and to assess the hospital costs. Methods: A study was carried out in four Belgian hospitals. Inpatients, who are still hospitalized while the medical discharge authorization goes back more than 24 hours, were identified over a period of 21 or 30 days. The study focuses on 93 inpatients. Results: We distinguish four profiles of bed blockers. 33% of inpatients are waiting for a bed in a retirement home (group A). They have an average length of delay (standard deviation) of 13 days (12), which represents an average cost per patient of EUR 8,197 for the hospital. Group B inpatients require temporary support to restore their autonomy before returning to their natural home environment (21%). They have an average length of delay of 3 days (2), which embodies an average cost of EUR 2,392. Inpatients in group C need rehabilitation after hospitalization (34%). They have an average length of delay of 11 days (18), which represents an average cost per patient of 10,070 EUR. Group D includes inpatients for whom there are no or few non-hospital facilities. They represent 11% of population and have very diverse and heterogeneous profiles. The main obstacle to the discharge from the hospital is a problem of availability or a lack of adapted health care services. Discussion/Conclusion: The results show the need to develop rehabilitation beds and retirement homes as the first solution to allow patients to discharge in a reasonable time.