CONCORD, NH – A March 2024 report by the New Hampshire Hospital Association and the Foundation for Healthy Communities shows that patients who no longer have medical needs are stuck in hospital beds unable to safely leave the hospital. A number of barriers lead to delays in discharge.
Barriers such as Medicaid enrollment, housing insecurity, securing guardianship and the need for specialized services that are not available can create significant roadblocks to discharge. “The delays not only affect the patients in the hospital, but also those who require inpatient beds and must wait in Emergency Departments (ED) for a bed to become available,” said New Hampshire Hospital Association President Steve Ahnen. “The obstacles to discharge present substantial challenges for hospitals as well, straining resources including beds, staff and medical supplies. Additionally, there are financial ramifications, as hospitals bear the cost when patients no longer have a medical need to stay in a hospital bed.”
According to the report, which reflects a snapshot of all patients from the 20 participating acute care hospitals on a single day during the first week of March 2024, 129 patients were in the hospital after medical clearance for discharge, with 38 patients in the ED waiting for an inpatient bed. Looking at just one of the possible discharge locations, long-term care, 66 patients spent a median 60 extra days beyond what was medically necessary. The reasons are numerous and varied:
*Lack of guardians for patients who do not have the capacity for decision-making
*Delays related to long-term care Medicaid enrollment
*Need for specialized services such as one-to-one care, substance use disorder treatment and behavioral health assistance
*Patients abandoned at hospitals by families and caregivers who no longer have the capacity or resources to continue to care for the person at home
“Despite not being set up to take care of patients long-term, the heroic efforts of hospital staff, who go above and beyond, cannot be overlooked,” said Kris Hering, Vice President, Quality Improvement, Foundation for Healthy Communities.
Hospitals have a duty to ensure that patients receive care in the most appropriate setting, and barriers to discharge make that a challenge. While efforts are underway to address these barriers – collaboration among health care providers, streamlining of processes and enhancing transition services – there is no one quick solution. Due to these many complex issues, the New Hampshire Hospital Association has asked the New Hampshire legislature to support SB 185, a legislative bill that would establish a study committee to evaluate and develop viable statewide solutions to address these concerns, in partnership with health care leaders. Still, hospitals are always there, ready to care, and consistently put patient well-being at the top of their priority list.
To view the Barriers to Discharge Report, visit nhha.org/press-releases/ or healthynh.org/press-releases/.