Some patients may be getting discharged from hospitals before they're ready because the hospitals simply need more space.
Two new studies in Heath Care Management Science found a correlation between readmission rates and how full the hospitals were at the time of a patient's discharge, suggesting that many patients went home before they were fully healed.
One study found that "surgeons adjust their discharge practices to accommodate the surgical schedule and number of available recovery beds," citing higher discharge rates when a lot of the facility's beds are in use.
Another looked at data from 7,800 surgeries performed in 2007 at a U.S. hospital and found that patients "who are discharged from a highly utilized post-operative unit" – that is, a busy hospital – "are more likely to be readmitted within 72 [hours]."
That same study found that each additional bed that's in use at the time of a patient's discharge from a hospital increases the odds of readmission by an average of 0.35 percent.
"Discharge decisions are made with bed-capacity restraints in mind," said Bruce Golden, a professor at the University of Maryland and a researcher for both of the studies, in a statement. "Patient traffic jams present hospitals and medical teams with major, practical concerns, but they can find better answers than sending the patient home at the earliest possible moment."
He added that hospitals and surgeons are incentivized to perform as many surgeries as possible.
"The hospital has to maintain revenue levels to meet its financial obligations," Golden explained. "Surgeons are working to save lives and earn a livelihood. It's what they do. If the hospital says 'Sorry, there are no beds available,' there's a lot of tension and pressure from both sides to keep things moving."
The solution for hospitals is simple, says Golden: Get more organized.
"Too often, the biggest problem is that hospitals just don't plan ahead, and this is what gets them in trouble," he said, suggesting that surgeons use checklists before discharging patients and increase the flexibility of where patients can go after surgery.
That won't keep costs down in the short-term, he admitted, but on the whole it will help save money spent on readmission and and increase the quality of care.
There may be another factor at play, at least in California: State hospitals will need to whittle patient numbers down in order to remain financially sustainable when one measure of the Affordable Care Act kicks into gear in 2015, causing hospitals to get paid less per patient.
That's years down the road, but already hospitals are looking for ways to get a head start on finding the most cost-effective way to remain in operation – something that, worst-case scenario, could mean discharging patients before they're completely ready to leave.
Photo by Mark Hillary via Flickr Creative Commons.