How a dedicated postdischarge unit can reduce hospital congestion and costs

Abstract

Depending on the patient's condition, up to 60% of inpatients are discharged to post–acute care facilities (PACFs). These patients may experience several days of nonmedical inpatient stay until the hospital finds a facility that fits their needs, contributing to overcrowding in upstream units. This article studies the feasibility of creating a “postdischarge unit” (PDU) for medically ready-for-discharge patients who experience transfer delays, to improve access to inpatient beds. We use a multistage stochastic program, solved with a dual dynamic programming algorithm, to address the PDU size and capacity question. The random variable is the number of bed requests from upstream units (e.g., emergency department). Our numerical analysis, using data from a large hospital, shows that a PDU can reduce costs and significantly reduce the number of patients waiting for transfer to PACFs that are occupying inpatient beds, as long as the percentage of these patients in the hospital is more than 4%. Compared to current practice in our partner hospital, a PDU could increase access to inpatient beds by up to 13% and result in 2%–21% cost savings. Results show that PDU capacity in hospitals with a larger number of patients waiting for transfer is more sensitive to variation in PDU renovation and operational costs. In addition to using fewer medical staff, a PDU can improve discharge transitions to lower levels of care and more efficiently utilize social workers and physical therapists assisting these patients.