Retraso del alta hospitalaria por motivos no médicos / Impact of delayed discharge for nonmedical reasons in a tertiary hospital internal medicine department

Antecedentes. Un alta diferida es la que se produce cuando, desde el punto de vista clínico, un paciente es dado de alta del hospital, pero continúa ocupando la cama por un problema no médico. Esta circunstancia sobrecarga el sistema sanitario, pero la frecuencia real de la misma y la pérdida de días útiles de hospitalización que ocasiona no han sido evaluadas en nuestro país hasta la fecha. Objetivo. Analizar la demora del alta efectiva por razones no médicas en un Servicio de Medicina Interna de un hospital de tercer nivel y determinar los factores clínicos y sociofamiliares asociados a esta situación. Pacientes y métodos. Estudio observacional y prospectivo, que analizó las características de los pacientes cuya alta se demoró por motivos no médicos durante 12 meses. Resultados. De las 4.850 altas que se produjeron en el Servicio de Medicina Interna, 170 (3,5%) se demoraron por problemas no médicos. Ello supuso una pérdida de 1.603 días útiles para hospitalización de otros enfermos. La mediana de demora fue de 5 días (rango: 3-12 días). Los pacientes con altas diferidas tenían una edad más avanzada, mayor prevalencia de enfermedad cerebrovascular aguda y problemas relacionados con el consumo de alcohol o benzodiacepinas. Los motivos principales aducidos para no irse de alta fueron: la sobrecarga y/o incapacidad de los familiares para el cuidado del enfermo por imposibilidad de conciliar los cuidados que requería con la vida laboral (51,8%), y la carencia de familiares o red de apoyo social (21,8%). Conclusiones. Las altas diferidas por motivos no médicos son frecuentes y están motivadas principalmente por dificultades sociofamiliares para hacerse cargo de los pacientes tras el ingreso hospitalario. Suponen una gran sobrecarga para los hospitales(AU)

Background. Delayed discharge occurs from a clinical point of view when a patient is considered medically fit for discharge but continues occupying a bed due to a nonmedical problem. This circumstance overloads the care system, however, its real frequency and loss of useful days of hospitalization have not being evaluated in Spain up to date. Objective. To analyze the frequency of hospital delayed discharges due to non-medical reasons in a tertiary hospital Internal Medicine Department and to determine the clinical and socio-familial factors related to this situation. Patients and methods. An observational and prospective study was performed to analyze the characteristics of the patients whose discharge was delayed for nonmedical reason over a 12-month period. Results. There were 4850 discharges in the Internal Medicine Department, 170 (3.5%) of which were delayed because of nonmedical problems. This accounted for a loss of 1603 useful days of hospitalization for other patients within one year. The median delay was 5 days (range: 3-12). Patients with delayed discharges were elder and had a higher prevalence of acute cerebrovascular disease as well as alcohol or benzodiazepines use related problems. The main causes were the overload or inability of the family to care for the patient and the impossibility to combine patient care with the family's working life (51.8%), and lack of family or social support network (21.8%). Conclusions. Delayed discharges for nonmedical reasons are frequent and mainly motivated by social-familiar problem to take charge of the patients after their hospitalization. This accounts for a significant overload for the hospitals(AU)

[Impact of delayed discharge for nonmedical reasons in a tertiary hospital internal medicine department]. / Retraso del alta hospitalaria por motivos no médicos.

BACKGROUND: Delayed discharge occurs from a clinical point of view when a patient is considered medically fit for discharge but continues occupying a bed due to a nonmedical problem. This circumstance overloads the care system, however, its real frequency and loss of useful days of hospitalization have not being evaluated in Spain up to date. OBJECTIVE: To analyze the frequency of hospital delayed discharges due to non-medical reasons in a tertiary hospital Internal Medicine Department and to determine the clinical and socio-familial factors related to this situation. PATIENTS AND METHODS: An observational and prospective study was performed to analyze the characteristics of the patients whose discharge was delayed for nonmedical reason over a 12-month period. RESULTS: There were 4850 discharges in the Internal Medicine Department, 170 (3.5%) of which were delayed because of nonmedical problems. This accounted for a loss of 1603 useful days of hospitalization for other patients within one year. The median delay was 5 days (range: 3-12). Patients with delayed discharges were elder and had a higher prevalence of acute cerebrovascular disease as well as alcohol or benzodiazepines use related problems. The main causes were the overload or inability of the family to care for the patient and the impossibility to combine patient care with the family's working life (51.8%), and lack of family or social support network (21.8%). CONCLUSIONS: Delayed discharges for nonmedical reasons are frequent and mainly motivated by social-familiar problem to take charge of the patients after their hospitalization. This accounts for a significant overload for the hospitals.