DIFFERENCES IN PERCEIVED BARRIERS TO HOSPITAL DISCHARGE WITHIN AND OUTSIDE THE CONTROL OF THE HOSPITALIST

Background: Discharge delays are associated with excessive costs to healthcare systems and poor patient outcomes. We sought to identify perceived barriers to timely discharge within and outside the control of hospitalists from the multidisciplinary team pivotal to the discharge process, and if different professionals noted different barriers.

Methods: In June 2024, we surveyed hospitalist physicians/advanced practice providers (APPs), physical therapists, occupational therapists, nurses, and case managers/social workers at 7 Emory Division of Hospital Medicine clinical sites.

Results: We received responses from 148 respondents: 61 physicians/APPs, 24 nurses, 34 physical therapists/occupational therapists, and 29 case managers/social workers. Most participants had >8 years of experience, except among the social workers/case managers, who most frequently had 0-3 years of experience. The top 4 barriers within the control of the hospitalist identified: discharge barriers not clearly discussed with the caregiver (n=98) 40% hospitalists, 17% nurses, 25% PT/OT, 18% SW/CM, perception of lack of a safe discharge (n=79) 55% hospitalist, 13% nurses, 17% PT/OT 14% SW/CM, delays in placing PT/OT orders (n=64), 33% hospitalist 3% nurses 46% PT/OT 17% SW/CM and the discontinuation of care items (n=59). 55% Hospitalist, 18% nurses, 12% PT/OT, 14% SW/CM. The top barriers not within the hospitalist’s control were limited resources for complex patients (n=112)43% hospitalist, 13% nurses, 21% PT/OT, 22% CM/SW; delays in referrals to home health rehab, etc. (n=77) 44% hospitalist, 15% nursing, 30% PT/OT and 10% SW/CM; processing orders for imaging/interventional radiology procedures (n=72) 44% hospitalist 11% nursing 28% PT/OT and 17% SW/CM; and difficulty obtaining post-hospitalization coverage for medication, equipment, etc. (n=72).

Conclusions: We can potentially improve hospital throughput by facilitating timely discharge, and substantially reduce costs associated with delayed discharges by creating an intervention to evaluate improvements in discharge procedures based on the survey’s findings.