In a small study of hospitalized patients, those who felt ready to go home when they were discharged were more satisfied with the hospital and their caregivers than those who didn’t feel ready to go.
It may be useful to use patient readiness for discharge as one measure of quality of care, the authors write in the Journal of the American College of Surgeons.
Readiness for discharge was not, however, tied to how often patients were later readmitted to the hospital, they found.
“In general, the length of hospitalization is determined by the amount of time it takes for patients to return to a state of health that will allow the remainder of their recovery to be done safely outside the hospital,” said senior author Dr. Emily R. Winslow of the University of Wisconsin School of Medicine and Public Health in Madison.
In this study, most patients were hospitalized for small bowel obstruction, which is marked by abdominal pain, nausea or constipation and can have many causes, like hernias or Crohn’s disease. Some cases require surgery while others do not.
“For patients with bowel obstructions in particular, the length of the hospital stay is predicated primarily on the time to resolution of the obstruction,” Winslow told Reuters Health by email. “For patients treated without surgery, some will resolve the obstruction much more quickly than others and will therefore require shorter hospital stays.”
The researchers used data from two surveys completed by 220 adults admitted to the hospital with small bowel obstruction and 98 patients with other conditions who stayed in the hospital for at least 21 days between 2009 and 2012. On one survey, the patients answered the question “did you feel ready for discharge?”
About 55 percent of participants felt “very good” about being discharged. These people were considered ready for discharge.
In this group, 87 percent were satisfied with the hospital experience overall, compared to 62 percent of those who were less ready for discharge. Those ready for discharge also tended to be happier with their communication with doctors and nurses.
About 11 percent of those in the ready for discharge group were readmitted to the hospital within 30 days, while 18 percent in the less ready group were readmitted.
Patients may be reluctant to be discharged because they do not feel adequately recovered to assume the remaining portions of their care at home, may not have adequate social and family support to help with the needed medical duties or may have persistent symptoms or pain, Winslow said.
There are risks of prolonged hospitalization, like blood clots or hospital acquired infections, and payment and insurance issues may also drive the trend toward shorter hospital stays, she said.
“Our results suggest that these issues are related to the general problems of discharge from an inpatient to an outpatient setting and not to a particular disease or patient group,” Winslow said. “One important caveat is that this study did not include several important subsets of patients – children, adults discharged to nursing facilities and those hospitalized for psychiatric problems.”
Hospitals also have growing incentive to prevent hospital readmission, which can be costly, said Marianne Weiss of Marquette University College of Nursing in Milwaukee, who was not part of the new study.
“Some readmissions within 30 days are not paid for,” Weiss told Reuters Health. “There is an incentive to make sure the patient is ready to go home.”
Elderly patients living alone tend to feel less ready to go home, she added.
“We start discharge planning on the day of admission, asking the patient and family early on what sorts of resources they are going to need and how they are going to manage their care at home,” Weiss said.
The healthcare team should start asking these questions early, as should patients and family members, she said.
“Patients and families who are actively engaged in their care and initiate early and frequent discussions with their health care team about when discharge is likely to occur and what will be expected of them and their caretakers once they are discharged will be best prepared when the day of transition comes,” Winslow said.
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