Reasons for delayed discharge of trauma patients.

BACKGROUND: In the trauma population, increased length of stay is associated with age, comorbidities, and injury severity. We hypothesized that a significant contributor to a delay in length of stay was unrelated to these variables.
MATERIALS AND METHODS: All trauma patients admitted for > 48 h with acute injury from 7/1/2000 to 9/30/2000 were evaluated daily for discharge readiness. Actual discharge time was recorded from the time discharge orders were written. A discharge-ready patient not discharged within 24 h was a Delay discharge. Discharge delay was categorized as availability of rehabilitation beds, family reasons, or system-related delay. Payer was classified as commercial, government, Medicare, or uninsured. Actual hospital costs were used.
RESULTS: One hundred twenty-eight patients were evaluated; 30 patients had a delay in discharge. The average delay was 2 days (range 1-15 days). Mean hospital stay for Delay patients was 13.4 days, and 8.1 days for Timely patients (P < 0.05). Injury severity, age, and comorbidities were not different among groups. The main reason for delay was lack of a rehabilitation bed. Hospital costs were $39,013 per patient in the Delay group and $24,414 in the Timely group. Delay patients were more likely to be uninsured, have an orthopedic injury, and require ICU care.
CONCLUSION: Discharge delays significantly lengthen hospital stay for nonmedical reasons in trauma patients. Improved efficiency in a trauma system will require changes from acute care to rehabilitation.