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Submitted: 01 June 2018 Modified: 09 November 2018
HERDIN Record #: R07-VSMMC-18060115250778

Factors of delayed hospital discharge among post partum patients admitted at VSMMC: A prospective evaluation.

Yasmin S. Marave

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INTRODUCTION: Delays in discharge from hospitals are a critical challenge for many health care systems in industrialized nations. These delayed discharges are hospital episodes where a patient exceeds the length of stay deemed medically necessary. They are commonly associated with, though not exclusive to, older adults. Delayed discharges represent a minority of hospital cases, yet they often have a substantial influence on patient flow throughout the hospital. A number of studies have reported on factors that influence the duration of hospital stay and delay of discharge from hospital. Less is known, however, about the characteristics of patients who make up the discharge delay list or the incidence and prevalence of such patients.


METHODS: This prospective observational study was conducted at the department of Obstetrics and Gynecology. In the event that delayed discharge was found in particular patient, the researcher identified possible reason of such delays. Several procedures were followed for a specific type of delayed discharge. For cases of unsettled accounts, the researcher asked nurses regarding unsettled bill if this could be considered as culprit, for undischarged baby etc. The researcher inquired in the nursery department for confirmation; for cases of blood transfusion, referrals to patients' medical charts were conducted to verify if this procedure was done. The same procedure was followed for co-morbidities, wherein the researcher reviewed the medical charts of these patients. Lapses were then checked if the main culprit of delayed discharge of patients were doctors and other health care professionals. As soon everything was gathered, the researcher started encoding all data in Excel.


 RESULTS: In this study, many experienced delay in terms of hospital discharge (4,554; 95.8%); and were in the OB abnormal categories (3,124; 68.6%). Most patients were 18 to 29 years of age (190; 94.53%); finished secondary education (255; 97.3%); were earning a minimum wage (267; 94.7%); were employed (266; 94.7%). Majority of patients in this study were single (243; 95.7%); and had one child (131; 94.9%).  Factors for delayed hospital discharge were due to undischarge babies (154; 100%); unsettled accounts (91; 100%); co-morbidities (55; 100%).  The largest number patients have improved medical condition (315; 94.9%).


CONCLUSIONS:The data disclosed in this research yielded that Ninety five percent of OB patients admitted had delayed discharge.  Majority of patients or sixty eight percent with delayed discharged belonged to OB abnormal. Among those with delayed discharge belonged to age group 18 - 29 years old, with educational attainment of secondary level, earning minimum wage, but most were unemployed. Due to this, patients noted in this study were not able to gain good employment which offers higher wage. Strikingly, most patients with delayed discharge were single and have 1-3 children. The factor that caused most of the delay in the discharge of patients was undischarged babies with forty six percent. Most of the patients with delay in discharge had improved maternal outcomes.

Publication Type
Research Project
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Vicente Sotto Memorial Medical Center Abstract Print Format
1. Rockwood, . "Delays in the discharge of elderly patients." J ClinEpidemiol 43, 971–975, 1990
2. Victor, C , Nazareth , B , Hudson, M , Fulop, N . "The inappropriate use of acute hospital beds in an inner London district health authority" Health Trends 25, 94–97, 1993
3. Bakheit, AMO , McLellan, DL . "The impact of the Community Care Act on bed turnover in a rehabilitation unit" ClinRehabil 9, 70–73, 1995
4. Reding, MJ , LaRocca, N , Medonna, M . "Acute-hospital careversus rehabilitation hospitalisation for management of non-emergentcomplications in multiple sclerosis" JNeurolRehabil 1, 13–17, 1987
5. Carter and Wade (200, . "Delayed discharges from Oxfordcity hospitals: who and why?" ClinicalRehabilitation 16, 315–320, 2002
6. Hakim, EA , Bakheit, AMO . "A study of the factors which influence the length of hospital stay in stroke patients" ClinRehabil 12, 151–56, 1998
7. Feigenson, JS , Fletcher , H , McDowell, FH , et al, . "Factors in influencing outcome and length of stay in a stroke rehabilitation unit" Stroke 8, 651–56, 1977
8. Anderson, P , Meara, J , Brodhurst, S , et al, . "Use of hospital beds: a cohort study of admissions to a provincial teachinghospital" BMJ 297, 910–12, 1988
9. ALC Expert Panel, . Appropriate level of care: A patientflow, system integration and capacity solution. Toronto: Ministry of Health andLong-Term Care, 2006.
10. Rock, BD , Beckerman, A , Auerbach, C , Cohen, C , Goldstein, M , Quitkin, E . "Management of alternate level of care patients using acomputerized database" Health Soc Work 20, 133–139, 1995
11. Abe, Y , Ai, M , Kaneko, M , Sawara, M , Nagano, K . "Studies on factors related to delayed discharge of elderly patients from university hospitals" Nippon Ronen IgakkaiZasshi 44, 641–647, 2007
12. Baumann, M , Evans, S , Perkins, M , Curtis, L , Netten, A , Fernandez, JL , Huxley, P . "Organisation and features of hospital, intermediate care and social services in English sites with low rates of delayed discharge" Health Soc Care Community 15, 295–305, 2007
13. Black, D , Pearson, M . "Average length of stay, delayed discharge, and hospital congestion" BMJ 325, 610–611, 2002
14. Epstein, J , Kaplan, G , Lavi, B , Noy, S , Ben, Shahar I , Shahaf, P , Stanger, V , Rotstein, Z . "A description of inappropriate hospital stays in selected in-patient services: a study of cases receiving social work services" Soc Work Health Care 32, 43–65, 2001
15. Rae, B , Busby, W , Millard, PH . "Fast-tracking acute hospital care–from bed crisis to bed crisis" Aust Health Rev 31, 50–62, 2007
16. Scott, H . "Elderly patients: people not " Br J Nurs 9, 528, 2000
17. Costa et.al., (2012), . "Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region" BMC Health Services Research 12, 172, 2012. Retrieved from: http://www.biomedcentral.com/1472-6963/12/172
18. Booth, A , Mead, T . (2006, November 30). Delayed transfer of care. Health Management Specialist Library. [WWW document]. . Retrieved from: URL http://www.library.nhs.uk/healthmanagement/
19. Coffey, A . "Discharging older people from hospital to home: what do we know?" International Journal of Older People Nursing 1, 141–150, 2006
20. Glasby, J , Littlechild, R , Pryce, K . "All dressed up and nowhere to go? Delayed hospital discharges and older people" Journal of Health Services Research & Policy 11, 52–58, 2006
21. Swinkells, , Mitchells, . "Delayed transfer from hospital to community settings: the older person’s Perspective" Health and Social Care in the Community 17 (1), 45–53, 2008
22. National Audit Offic, . Ensuring the Effective Discharge of Older Patients from NHS AcuteHospital Settings. London: The Stationery Office, HC392
23. Department of Health, . The Community Care (Delayed Discharges etc.) Act. London: Department ofHealth,
24. Nolan, M , Grant, G , Nolan, J . "Busy doingnothing:activity and interaction levels amongst differing populations of elderlypatients" Journal of Advanced Nursing 22, 528–538, 1995
25. Sager, M , Franke, T , Inouye, S.K , Landefield, C.S , Rudberg, M.A , Siebens, H , Wingrad, C.H . "Functional outcomes of acute medical illness and hospitalisation in older persons" Archives of Internal Medicine 156, 645–652, 1996
26. Brown, C.J , Friedkin, R.J , Inouye, S.K . "Prevalence and outcomes of low mobility in hospitalised older patients" Journal of the American Geriatrics Society 52, 1263–1270, 2004
27. Callen, B.L , Mahoney, J.E. , Grieves, C.B. , Wells, T.J. , Enloe, M . "Frequency of hallway ambulation by hospitalized olderpatients on medical units of an academic hospital" Geriatric Nursing 25, 212–217, 2004
28. Glasby, J . "Discharging responsibilities? Delayedhospital discharges and the health and social care divide Journal of Social Policy" 33(4), 593–604, 2004
29. Bull, M.J. , Roberts, J. . "Components of aproper hospital discharge for elders" Journalof Advanced Nursing 35(4), 571–581, 2001
30. Payne, S. , Kerr, C. , Hawker, S. , Hardney, M. , Powell, J. . "The communication of information about older people between health andsocial care practitioners." Age and Ageing 31, 107–117, 2002
31. National Audit Offic, . Ensuring Effective Discharge of Older Patients from NHS Acute Hospitals. London: The Stationery Office,
32. Scottish Executive, . A Research Review on Tackling Delayed Discharge. Edinburgh: ScottishExecutive,
33. Whiteford, LM , Szelag, BJ . "Access and utility as reflections of cultural constructions ofpregnancy" Prim. Care Update Ob.Gyns 7, 98–104 , 2000
34. Rossiter , JC . "Attitudesof Vietnamese women to baby feeding practices before and after immigration toSydney" Midwifery 8, 103–12, 1992
35. Fuentes-Afflick, E , Hessol , NA . "Impact of Asian ethnicity and national origin on infant birthweight" Am. J. Epidemiol 15, 148–55, 1997
36. Rossiter , JC . "Maternal-infant health beliefs and infants feeding practices: The perceptionand experience of immigrant Vietnamese women in Sydney" Contemp. Nurs 1, 75–6, 79–8, 1992
37. Brown, S , Lumley, J , Small, R. l . "Early obstetric discharge: does it make a difference to healthoutcomes?" Paediatr. Perinat.Epidemio 12, 49–71, 1997
38. Margolis, LH , Kotelchuck, M , Chang, HY . "Factors associated with early maternal postpartum discharge fromthe hospital" Arch. Pediatr. Adolesc.Med 151, 446–72, 1997
39. Mcgrath, B , Chung, F . "Postoperative recovery and discharge" Anesthesiol Clin N Am 21, 367–386, 2003
40. Pavlin, DJ , Chen, C , Penaloza, DA , Polissar, NL , Buckley, FP . "Pain as a factor complicating recovery and discharge after ambulatory surgery." Anesth Analg 95, 627, 2002
41. Laplana, . Geographic Origins of Referred Obstetric Patients at Vicente Sotto Memorial Medical Center (VSMMC): A Retrospective Analysis. VSMMC, 2016.
42. Triggleet.al, . "Squeeze on social care blamed for delay in discharges fromhospital" Vol 6. No., 2014
43. Parisi, VM , Meyer, BA . "To stay or not to stay? That is the question" New England Journal of Medicine 333, 1635±1637, 1995
44. Brown, S , Lumley, J . "The 1993 Survey of Recent Mothers: issues in survey design, analysis andinfluencing policy" International Journal of Quality in Health Care 9, 265±277, 1997
45. Rush, J , Chalmers, I , Enkin , M . "Care of the new mother and baby. In: Effective Care in Pregnancy and Childbirth" Oxford: Oxford University Press Vol. 2, 1333±1345, 1989
46. Brown, S , Lumley, J , Small, R . "Early obstetric discharge: does it make a difference to health outcomes?" Pediatr. Perinat.Epidemiol 12, 49–71, 1997
47. Margolis, LH , Kotelchuck, M , Chang, HY . "Factors associated with early maternal postpartum discharge from the hospital" Arch. Pediatr. Adolesc. Med 151, 446–72, 1997
48. Braveman, P , Egerter, S , Pearl, M , March, K , Miller, C . "Problems associated with early discharge of newborns and mothers: A critical review of the literature" Pediatrics 96, 716–26, 1995