Discharges are commonly delayed for investigations that will not change acute management. Examples include biopsies, imaging to further investigate incidental findings, assessment by a specialist that is non-urgent, waiting for bloodwork results as part of a non-urgent diagnostic work-up, or echocardiography for patients with mild heart failure. Delayed discharges contribute to hospital over-crowding and negatively impact care efficiency. Crucially, longer lengths of stay is a risk factor for nosocomial infections, venous thromboembolism, pressures injuries, immobility, malnutrition, and deconditioning. Consider outpatient investigations when possible, if good follow-up can be assured.

Conditions: Discharge of hospital inpatients, nosocomial infections, venous thromboembolism, pressures injuries, immobility, malnutrition, deconditioning

Diagnostic Tests: Non-urgent investigations

Procedures: Non-urgent procedures

Sources

• Bhatia RS, et al. An education intervention reduces the rate of inappropriate echocardiograms on an inpatient medical service. JACC Cardiovasc Imaging. 2013 May;6(5):545-55. (PubMed)
• Canadian Association of Emergency Physicians. Overcrowding [Internet]. 2017 [cited 2017 May 19]. Available from: http://caep.ca/advocacy/overcrowding.
• Gundareddy VP, et al. Association between radiologic incidental findings and resource utilization in patients admitted with chest pain in an urban medical center. J Hosp Med. 2017 May;12(5):323-8. (PubMed)
• Laurencet ME, et al. Early discharge in low-risk patients hospitalized for acute coronary syndromes: feasibility, safety and reasons for prolonged length of stay. PLoS One. 2016 Aug 23;11(8):e0161493. (PubMed)
• McNicholas S, et al. Delayed acute hospital discharge and healthcare-associated infection: the forgotten risk factor. J Hosp Infect. 2011 Jun;78(2):157-8. (PubMed)
• Richardson DB. The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay. Med J Aust. 2002;177:492-5. (PubMed)
• Webster BS, et al. The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain. Spine (Phila Pa 1976). 2014 Aug 1;39(17):1433-40. (PubMed)