CHA News

Growing Discharge Delays Leading to Hospital Overcrowding, Other Problems

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California hospital patients are experiencing frequent, lengthy, and costly delays in care transitions. That’s the finding of a new CHA member survey investigating the extent and impact of discharge delays in three key hospital settings: emergency departments (EDs), general acute care, and inpatient psychiatric care.   

While such challenges are long-standing, the volume of the delays has increased in recent years and has emerged as a major operational issue with a significant impact on hospital capacity, utilization of scarce staffing resources, and the ability to control costs.   

Among the survey’s major findings:    

  • CHA estimates that at least 5,000 patients every day will see their discharge avoidably delayed long after they are deemed medically ready for discharge. This includes 2,250 patients in general acute care, 750 in acute psychiatric care, and another 2,000 temporarily boarded in EDs.    
  • Among the most important factors contributing to avoidable delays are the availability of beds in less acute settings (78% of respondents identified skilled-nursing facilities as the discharge destination most frequently associated with delays) and delays or denial of authorization from insurance companies. Payer mix also appears to be an important determining factor, as we estimate Medi-Cal patients are 2.5 times more likely to experience avoidable discharge delays and Medicare patients are 1.5 times more likely
  • On average, avoidable discharge delays add an additional 14 days to affected inpatient stays in general acute care, 25 days to those in psychiatric care, and 11 hours to those in the ED. We estimate these typically uncompensated boarding days and hours cost hospitals at least $2.9 billion annually

Additional information will be provided to CHA members in the future. CHA will use these data to support our key messages about this important issue and to inform ongoing advocacy for policies that support timely access to care and the preservation of acute hospital services.