Do discharge delays explain longer stays at veterans health administration hospitals?

Discharge delays are difficult to quantify without standardized indicators for when patients are medically ready for discharge. We aimed to estimate the proportion of increased hospital length of stay attributable to discharge delays, as proxied by increases in 'avoidable' days.

We conducted a retrospective cohort study of Veterans Health Administration hospitals in the continental United States with emergency departments between 1 March 2019 and 28 February 2023. We included Veterans who were discharged from an acute medicine service without a COVID-19 diagnosis. We used standardized utilization management criteria to count 'avoidable' days, defined as hospital days when acute care was no longer required. Our primary outcome was geometric mean length of the discharging stay (the final acute medicine segment prior to discharge), which reflects the time most susceptible to discharge delays.

During the study period there were 868,031 eligible hospitalizations. Adjusted geometric mean length of discharging stay increased 9.3% (95% CI, 8.7% to 9.9%) from the pre-pandemic year to the third pandemic year, with the largest increase among discharges to facility-based post-acute care (23.3% [95% CI, 21.6 to 24.9%]). However, among all hospitalizations only 16% (95% CI, 15 to 17%) of the increase in discharging stay was attributable to an increase in avoidable days.

Most of the increase in length of hospital discharging stay was not explained by discharge delays and may instead reflect longer periods of acute care delivery. Improving acute care processes may more effectively reduce hospital capacity strain than bolstering post-acute care availability.