What Factors Increase Odds of Long-Stay Delayed Discharge in Alternate Level of Care Patients?

Abstract

Background: Patients no longer requiring the current level of care they are receiving, but continue to be delayed from discharging, are designated as Alternate Level of Care (ALC) patients. These patients add to the continued challenge surrounding hospital overcrowding. We assessed risk factors of long-stay ALC patients; patients who have been delayed more than 30 days. Objective: The primary objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in ALC patients. Methods: We conducted a retrospective cohort study utilizing data from Niagara Health’s WTIS database between September 2014 and September 2019. We compared hospital location, demographic and needs/barriers factors pertaining to regular versus long-stay ALC patients using logistical regression analysis. Results: Of the 16,436 patients, 1,679 (10.2%) were considered long-stay ALC patients. Long-stay ALC patients were more likely to be male (OR=1.22, [1.08-1.38]), be directly admitted as opposed to through the ED (OR=1.30), currently occupy a convalescent care bed (OR=5.52, [1.66-18.37]) or mental health bed (OR=9.75, [2.36-36.17]) and have a discharge destination of an LTC bed (OR=66.39, [26.22-168.09]). Each present barrier increased the odds of becoming long-stay ALC by 44%. Odds were also increased by the presence of a bariatric (OR=6.13, [2.98-12.59]), feeding (OR=6.48, [1.92-21.92]) or infection (isolation) (OR=2.03, [1.49-2.77]) barrier. Conclusions: Long-stay ALC patients were more likely to be directly admitted, males with discharge destinations to LTC and assisted living facilities with the presence of bariatric, feeding and/or isolation requirements.