Healthcare News & Insights

Could early discharges cost instead of save?

Like all businesses, hospitals have to make money in order to stay in business. You can’t treat patients without staff, equipment, medications, etc., and that all requires money. But is making money sometimes done at the expense of patients’ health?

According to two new logistical studies, the answer is yes.

Researchers at the University of Maryland’s Robert H. Smith School of Business, which conducted both studies, found revenue-driven surgery and poor planning drive some surgical patients home before they’re fully recovered. Specifically, they showed a correlation between readmission rates and bed capacity at the time of discharge.

This issue, noted the researchers, is more likely in large hospitals that often provide more advanced, specialized surgeries not available at smaller, community facilities.

The studies, which examined the impact of hospital utilization on patient readmission rates and the discharge practices of surgeons at a large medical center, were published in the two most recent issues of Health Care Management Science.

They looked at surgical discharge data from fiscal year 2007 covering more than 7,800 surgery patients who collectively spent 35,500 nights at a large U.S. medical center. They tracked occupancy rates, days of the week, staffing levels and surgical volume.

In the studies, patients who were discharged from the medical center when it was at its busiest were 50% more likely to return for treatment within three days.

Economics play a role

While the above statistic points to money as being a driver in discharges, Bruce Golden, professor at the University of Maryland, emphasized in a press release that is wasn’t the sole driver.

“The hospital has to maintain revenue levels to meet its financial obligations. Surgeons are working to saves lives and earn a livelihood. It’s what they do. If the hospital says, ‘Sorry, there are no beds available,’ there’s a lot of tension and pressure from both sides to keep things moving,” explained Golden, who conducted the research with Ph.D. student David Anderson and other colleagues.

While patient traffic jams present major problems for hospitals and medical teams, there have to be better alternatives to fixing the problem than sending patients home before they’re fully recuperated, noted Golden.

One alternative might be having surgeons use checklists before they discharge patients. The questions need to force them to think about the reasons they are discharging patients. Standardizing this process, like hospitals have done in other practice areas, will help make sure patients are fully recuperated when they return home.

Another option, suggested by the researchers, is for hospitals to be more flexible about where patients go after surgery. For example, allowing patients to be moved to other units with open beds could reduce premature discharges.

What does your facility do to make sure patients aren’t discharged until they are physically ready to return home? Share your process in the box below.








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