Extended Discharge Timeline for Older Adult Trauma Patients: An Increasing Threat to the Efficiency of Trauma Centers

Loss of community dwelling status is frequent after hospitalization for traumatic injuries in older adults. Arranging placement to a skilled nursing facility or an inpatient rehabilitation facility often causes a delay in discharge after the patient is medically stable, exacerbating bed capacity issues in health systems and unnecessarily exposing patients to hospital-related complications. This study aimed to identify characteristics associated with delayed discharge and to quantify temporal trends in discharge delays at a high-volume trauma center.

We retrospectively analyzed all trauma patients from 2018 to 2023 in our Level I trauma registry, excluding in-hospital mortalities. Patients living greater than 70 miles from our trauma center were excluded due to the need for long-distance transport. Patients were stratified by delayed discharge time vs discharge at medical readiness.

Of 17,886 patients, 1,091 (6.1%) had a delay in discharge, waiting an average of 4.9 days after medical readiness. Patients with delayed discharge were more likely to be older (65.1 vs 53.2 years, p < 0.001), female (50.1% vs 38.8%, p < 0.001), have a higher Injury Severity Score (12.4 vs 8.6, p < 0.001), and blunt mechanism (92.7% vs 80.4%, p < 0.001). In a multivariate analysis, Medicare beneficiary status and skilled nursing facility placement remained associated with delayed discharge. The time of the week that the patient was medically ready for discharge did not significantly affect the discharge delay duration.

Trauma patients with Medicare experience significant delays in discharge. Currently, an average of 5 patients await disposition in our trauma center, which has increased yearly from a low of 0.5 patients in 2018. Further investigation is needed to determine causes of increased delays, including insurance denial of inpatient rehabilitation.