Hospital acquired infections amongst inpatients experiencing delayed hospital discharge: an observational study in Wales.

Abstract

Delayed discharge of patients considered medically fit for discharge places operational and economic strain on National Health Service (NHS) hospitals, and it is unclear what harms may be experienced by patients who remain in hospital longer than clinically required. This study was conducted to describe the pattern of delayed hospital discharge, and the incidence of hospital acquired infections and hospital acquired pneumonia in adult inpatients experiencing delayed discharge. An observational study was performed where delayed discharge patient data (May - December 2022) from an acute district general hospital in Wales was mapped to a range of hospital and microbiology data systems to identify if, and when, an infection event occurred between the medically fit for discharge date and the actual discharge date. During the study period, 1047 admissions resulted in delayed discharge, accounting for 5.6% of all admissions and occupying ∼17.9% of the estimated potential bed days available. Several types of harms occurred in delayed discharge patients including hospital-acquired pneumonia (0.4 per 100 bed days of delayed discharge), respiratory infections (0.2 per 100 bed days of delayed discharge), and positive blood culture infections (0.1 per 100 bed days of delayed discharge). Amongst patients without HAP, mortality was 7% (95% CI 5-9) however amongst patients with HAP it was 39% (95% CI 27-51). The delay in discharge of medically fit patients causes a large reduction in hospital inpatient capacity. Additionally, this patient population experiences a considerable burden of infections, and of clinical cases of hospital acquired pneumonia which is of particular concern.