Hospital-acquired infections among inpatients experiencing delayed hospital discharge: an observational study in...

Delayed discharge of patients considered medically fit for discharge places operational and economic strain on UK National Health Service hospitals, and it is unclear what harms may be experienced by patients who remain in hospital longer than clinically required.

To describe the pattern of delayed hospital discharge, and the incidence of hospital-acquired infections and hospital-acquired pneumonia (HAP) in adult inpatients experiencing delayed discharge.

An observational study was performed where delayed discharge patient data (May to December 2022) from an acute district general hospital in Wales was mapped to a range of hospital and microbiology data systems to identify if, and when, an infection event occurred between the medically fit for discharge date and the actual discharge date.

During the study period, 1047 admissions resulted in delayed discharge, accounting for 5.6% of all admissions and occupying ∼17.9% of the estimated potential bed-days available. Several types of harms occurred in delayed discharge patients including HAP (0.4 per 100 bed-days of delayed discharge), respiratory infections (0.2 per 100 bed-days of delayed discharge), and positive blood culture infections (0.1 per 100 bed-days of delayed discharge). Among patients without HAP, mortality was 7% (95% confidence interval: 5-9); however, among patients with HAP it was 39% (27-51).

The delay in discharge of medically fit patients causes a large reduction in hospital inpatient capacity. Additionally, this patient population experiences a considerable burden of infections, and of clinical cases of HAP which is of particular concern.