B. Ali1, R. Clark1, L. Webb1, S. Cali1, F. Sadiq1, D. Ozathil1, R. McKee1 1University Of New Mexico,Surgery,Albuquerque, NM, USA
Introduction:
Barrier days (BD) or days awaiting placement (DAP) are days spent in the hospital awaiting placement after medical clearance for discharge has been obtained. Many trauma patients are uninsured or under insured. These days represent lost revenue from new admissions. They also potentially impact patient satisfaction due to long wait times for elective surgery as well as longer stays in the Emergency Room (ER). New Mexico is a resource poor state and in the last fiscal year, the University of New Mexico (UNMH) had 85% or more of its beds occupied over six months’ period in 2015. We sought to evaluate the magnitude of this problem and the cost associated with DAP in order to make a clear financial argument for dedication of resources to improve throughput.
Methods:
This was a retrospective pilot study. 400 patients admitted to the trauma service over a period of 6 months from July 2012 to December 2012 were reviewed. Chart review was performed to assess when patients were medically ready for discharge. Reasons for delay in discharge, number of extra days spent in the hospital, disposition and insurance type were recorded. Cost for the entire length of stay and average cost of each barrier day was calculated.
Results:
We identified 67 patients (16.5%) with DAP with a mean of 4.3 days and a median of 3 days. The insurance overage of these patients is shown in figure 1. Of 67 patients 35 had delays of less than or equal to 3 days while 31 patients had delays of more than 3 days. DAP represented 8.8% of total hospital charges and the aggregate cost for DAP over this 6 month period was $1.2 million (figure 2). Cost of an average barrier day was calculated to be $4010 (figure 3.) Overall length of stay had a linear relationship with DAP (figure 4). Final disposition can predict DAP as shown in fig 5.
The most common problems that we were able to identify on chart review were failure to involve social workers early in the process, delays in obtaining discharge recommendations from physical and occupational therapists, long waits for approval from receiving facility/insurance authorization, and inefficiency in communication with the primary team (figure 6).
Conclusion:
Barrier days represent significant cost and inefficiency within our hospital system. Assessing this cost can help guide administrators decisions to dedicate more resources or change processes and weigh the cost of these changes against the cost of barrier days.
