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Sorensen M, Sercy E, Salottolo K, et al. The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients. Patient Saf Surg. 2020;14:2doi: 10.1186/s13037-019-0227-z.
Sorensen, M., Sercy, E., Salottolo, K., Waxman, M., West, T. A., Tanner, A., Bar-Or, D., & Aminatun, D. (2020). The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients. Patient safety in surgery, 142. https://doi.org/10.1186/s13037-019-0227-z
Sorensen, Melissa, et al. "The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients." Patient safety in surgery vol. 14 (2020): 2. doi: https://doi.org/10.1186/s13037-019-0227-z
Sorensen M, Sercy E, Salottolo K, Waxman M, West TA, Tanner A, Bar-Or D, Aminatun D. The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients. Patient Saf Surg. 2020 Jan 06;14:2. doi: 10.1186/s13037-019-0227-z. eCollection 2020. PMID: 31911820; PMCID: PMC6945617.
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Patient Saf Surg. 2020 Jan 06;14:2. doi: 10.1186/s13037-019-0227-z. eCollection 2020.

The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients.

Patient safety in surgery

Melissa Sorensen, Erica Sercy, Kristin Salottolo, Michael Waxman, Thomas A West, Allen Tanner, David Bar-Or, Aminatun

Affiliations

  1. 1Trauma Services Department, Swedish Medical Center, Englewood, CO USA.
  2. 2Trauma Research Department, Swedish Medical Center, Englewood, CO USA.
  3. Trauma Research Department, Medical City Plano, Plano, TX USA.
  4. 4Trauma Research Department, Research Medical Center, Kansas City, MO USA.
  5. 5Trauma Research Department, Penrose Hospital, Colorado Springs, CO USA.
  6. 6Medical/Surgical Intensive Care Unit, Research Medical Center, Kansas City, MO USA.
  7. Trauma Services Department, Medical City Plano, Plano, TX USA.
  8. 8Trauma Services Department, Penrose Hospital, Colorado Springs, CO USA.
  9. Injury Outcomes Network Research Group, 501 E Hampden Ave, Englewood, CO 80113 USA.

PMID: 31911820 PMCID: PMC6945617 DOI: 10.1186/s13037-019-0227-z

Abstract

BACKGROUND: Hospital length of stay (HLOS) is a commonly used measure of hospital quality and is influenced by clinical and non-clinical factors. To reduce HLOS, it is key to identify factors placing patients at increased risk of lengthy HLOS and discharge delays.

METHODS: This was a retrospective cohort study of patients age ≥ 18 admitted to four level 1 trauma centers between 1/1/2015 and 3/31/2018 with traumatic brain injury (TBI). The primary outcome was discharge delay, defined as discharge ≥24 h after case management notes indicated the patient was ready for discharge. The independent variables of interest were primary insurance provider and discharge destination. Chi-square, Fisher exact, and unadjusted and adjusted logistic regression analyses were used to assess associations between discharge delay and the two primary independent variables, as well as other patient demographic and clinical characteristics. Complications developing during the delay period were also examined.

RESULTS: A total of 1543 patients with TBI were included. The median age was 61 years, and the median HLOS was 5 days. Approximately half of patients were discharged home (54%). The most common insurance providers were Medicare (35%) and commercial/private (35%). Two-hundred ten (14%) patients experienced a discharge delay. The median delay period was 3 days, and the most common reasons for delay were insurance authorization (52%) and lack of accepting bed (41%). Compared to being discharged home, patients discharged to a skilled nursing facility (adjusted odds ratio (AOR) = 10.35) or intermediate care facility (AOR = 10.64) had the highest odds of discharge delay. Compared to Medicare patients, uninsured/self-pay patients (AOR = 2.98) and those with Medicaid (AOR = 2.83) or commercial/private insurance (AOR = 2.22) had higher odds of delay. Thirty-two patients (15% of those delayed) experienced at least one complication during the delay, some of which were clinically severe.

CONCLUSIONS: A substantial portion of TBI patients in this study experienced discharge delays, and discharge destination and primary insurance provider were significant drivers of these delays. Evaluation of a facility's quality of care should consider the specific causes of these delays.

© The Author(s). 2020.

Keywords: Insurance; Patient discharge; Traumatic brain injury

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

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