Difficult hospital discharges in internal medicine wards

Intern Emerg Med. 2007 Jun;2(2):95-9. doi: 10.1007/s11739-007-0029-7. Epub 2007 Jul 9.


Objective: Investigate the prevalence of difficult hospital discharges (DHD), describe clinical and social patients' characteristics as potential reasons for discharge delays in an internal medicine ward and implement tailored post-discharge care.

Methods: During the year 2005 we analysed, in a middle-sized country hospital, all the patients for which some delay for discharge, owing to their whole complexity, was presumable. Comprehensive multidimensional assessment, clinical-social risk score, specific needs of care, mean of stay and outcomes were evaluated.

Results: 68.5% of DHD patients were >/=80 years old, with 3.8 the mean number of diseases per patient; 57.5% presented a loss of autonomy (ADL) just before acute deterioration; 80% were functionally and/or cognitively impaired. Only 5% had suitable family support; 5.1% were living at a nursing home; 2% were living alone. The most frequent causes of admission were stroke, cognitive impairment-dementia, cardiovascular diseases, fractures and cancer. Mean length of stay was 12 days. Fifty-two percent of patients were discharged home, 30% were admitted to a long-term care facility, 1% to hospice and 17% died during their hospital stay.

Conclusions: The aim of "coordinated care" (i.e., targeting "at-risk" patients with assessment of medical, functional, social and emotional needs; provision of optimal medical treatment, self-care education, integrated services, monitoring of progress and early signs of problems) is to improve health outcomes and reduce costs. More than 80% of DHDs patients, with specific tailored programmes, may be discharged from hospital, with satisfactory solutions for them and their families.

MeSH terms

  • Aged, 80 and over
  • Female
  • Geriatric Assessment
  • Hospital Units / statistics & numerical data*
  • Hospitals, County / statistics & numerical data
  • Humans
  • Internal Medicine / statistics & numerical data*
  • Length of Stay / statistics & numerical data
  • Male
  • Patient Admission / statistics & numerical data
  • Patient Discharge / statistics & numerical data*
  • Prevalence