Delays in care may lead to increased length of stay and cost. Identifying and quantifying the reasons for these delays could help target interventions and reduce unnecessary hospital days.


We conducted a cross-sectional observational study at a large tertiary academic medical center, from October 16, 2016 to November 20, 2016. The study participants were inpatient hospitalists on both teaching and direct-care medicine services.

Participants were surveyed daily via their smartphones. A locally developed software program used our scheduling system to automatically identify hospitalists on service and send them a text message with a personalized link to a web-based survey.

The survey asked physicians (1) how many of their patients experienced a delay in care that would likely lead to an extra day of hospitalization (an “avoidable day”), (2) which factor contributed most to the delay (multiple choice, single answer), and (3) more details on that particular factor (branching logic, multiple choice, multiple answer). The multiple choice, branching logic options for the survey were developed using data from a previous pilot study with the goal of minimizing effort to complete while still obtaining detailed data.


During the study period, we sent 210 daily surveys and received 100 responses (47.6% response rate). The total number of avoidable days reported was 110 (Table 1). The most commonly cited reason for an avoidable day was post-acute care issues related to placement (57/110, 51.8%), followed by procedure or imaging delays (31/110, 28.2%). Within post-acute care issues, physicians responded that difficult placements (25/57, 43.9%) and lack of available skilled nursing facility beds (10/56, 17.5%) were most responsible for delays. Within procedure or study delays, physicians reported that procedures performed by gastroenterologists – particularly endoscopies – were the most often delayed (17/34, 50%), followed by those performed by interventional radiologists (10/34, 19.6%).


Hospitalists reported that delays in care were most often due to post-acute care issues (51.8%) and procedures (28.2%), especially endoscopies. This data can be used to target interventions and collaborate with consultants to reduce delays. In addition, the study survey itself can easily be adapted for use at other hospitals to identify delays unique to their institution.