Inappropriately delayed discharge from hospital: What do we know?

doi:10.1136/bmj.326.7395.927

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Norman Vetter, reader (Vetter@cf.ac.uk)

Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XL

Correspondence to:

Accepted 20 February 2003

A patient's discharge from hospital can be classed as inappropriately delayed, thus causing bed blocking. However, is the inappropriateness in the hospital rather than in the patient?

Rising demand and a reduction in the number of available beds have greatly increased the turnover in hospital. The pressure to increase this even further has led to the concept of inappropriately delayed discharge. This is not confined to the United Kingdom and has been reported from Israel,1 United States,2 Norway,3 and New Zealand.4

I reviewed the evidence from systematic reviews identified through Medline, Embase, and the Cochrane collaboration and other studies identified during the search that appeared to contribute usefully to the debate. I excluded studies in obstetrics, paediatrics, and psychiatric care.

Summary points

The tools for measuring inappropriately delayed discharge all have poor validity and reproducibility

This is increased when local availability of alternative care is ignored

There is no evidence to show that in cases labelled as inappropriately delayed discharge, patients would have had better outcomes if they had been discharged earlier

Indeed, such patients may be appreciably unwell

Questions to be asked?

Discussion of inappropriately delayed discharge must take into account several questions:

Is the measure of inappropriateness valid and reproducible?
Is inappropriateness measured in relation to an ideal, where patients should be treated in another facility whether it exists or not; or does it regard patients as inappropriately delayed only when a more appropriate facility is available?
Is there good evidence that more appropriate facilities, whether theoretical or real, are better in terms of patient outcomes than the existing placement?