Don’t order non-urgent investigations or procedures that will delay discharge of hospital inpatients.

Discharges are commonly delayed for investigations that will not change acute management. Examples include biopsies, imaging to further investigate incidental findings, assessment by a specialist that is non-urgent, waiting for bloodwork results as part of a non-urgent diagnostic work-up, or echocardiography for patients with mild heart. Delayed discharges contribute to hospital over-crowding and negatively impact care efficiency. Crucially, longer lengths of stay is a risk factor for nosocomial infections, venous thromboembolism, pressures injuries, immobility, malnutrition, and deconditioning. Consider outpatient investigations when possible, if good follow-up can be assured.

 

Sources:
Bhatia RS, et al. An education intervention reduces the rate of inappropriate echocardiograms on an inpatient medical service. JACC Cardiovasc Imaging. 2013 May;6(5):545-55. PMID: 23582360.

Canadian Association of Emergency Physicians. Overcrowding [Internet]. 2017 [cited 2017 May 19].

Gundareddy VP, et al. Association between radiologic incidental findings and resource utilization in patients admitted with chest pain in an urban medical center. J Hosp Med. 2017 May;12(5):323-8. PMID: 28459900.

Laurencet ME, et al. Early discharge in low-risk patients hospitalized for acute coronary syndromes: feasibility, safety and reasons for prolonged length of stay. PLoS One. 2016 Aug 23;11(8):e0161493. PMID: 27551861.

McNicholas S, et al. Delayed acute hospital discharge and healthcare-associated infection: the forgotten risk factor. J Hosp Infect. 2011 Jun;78(2):157-8. PMID: 21497945.

Richardson DB. The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay. Med J Aust. 2002;177:492-5. PMID: 12405891.

Webster BS, et al. The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain. Spine (Phila Pa 1976). 2014 Aug 1;39(17):1433-40. PMID: 24831502.