Health and Social Factors Associated with a Delayed Discharge Amongst Inpatients on Acute Geriatric Wards: A Retrospective Observational Study

05 Feb 2018

Aim:  In the English National Health Service (NHS) there is an increasing interest in understanding the factors associated with delayed discharges in older hospitalised adults. This study sought to analyse whether clinical frailty was a significant and independent risk factor for having a delayed discharge when the data were controlled for potential health and social confounders. Methods: This was a retrospective observational study in an English NHS teaching hospital. We analysed all first hospitalisation episodes to the Department of Medicine for the Elderly between 1st May 2016 and 31st July 2016. A delayed discharge was operationally defined as a patient being discharged more than 24 hours after his/her last recorded clinically fit date.  Results: 924 cases were analysed. The independent risk factors for having a delayed discharge were: needing a new package of care (Odds Ratio [OR]=4.05, 95% CI: 2.68-6.10), new institutionalisation (OR=2.78, 95% CI: 1.67-4.62), living alone (OR=1.98, 95% CI: 1.40-2.81), delirium (OR=1.79, 95% CI: 1.17-2.74), and frailty (i.e. 5 or more on the Clinical Frailty Scale, OR=1.74, 95% CI: 1.15-2.63). Conclusion: Our results are consistent with previous reports that delayed discharges in older hospitalised patients are mainly related to new formal social care requirements in survivors of acute illness. Frailty was an independent risk factor for delay, but its effect may have been confounded by the unmeasured variable of informal care requirements. Our operational definition of delayed discharge does not mirror the legal definition of delayed transfer of care in England and results are not externally valid.