Stuck in the hospital

[edschweppe]

Front-page story in today's Boston Globe: Patients 'stuck' in hospitals complicate care

Over the past year, an average of 1,200 people were stuck in Massachusetts hospital beds each day because workers could not find a place to discharge them, a new report says, in the latest sign that hospitals continue to struggle with overcrowding even as the COVID pandemic has ebbed.

The patients occupied approximately 15 percent of the state's staffed medical and surgical hospital beds, according to data from March 2022 through February this year, creating backups in emergency rooms as other patients waited to be admitted.

"Even as the public health emergency has come to an end, our health care system is still in major distress," said Steve Walsh, president and CEO of the Massachusetts Health & Hospital Association, which released the report Monday. "This backlog of stuck patients is playing a major role in driving up wait times and obstructing access to care."

The crowding has eased somewhat in recent months, but large percentages of patients are still waiting to be discharged for more than 30 days. The bottlenecks have operational and financial implications, creating delays for ambulances to offload patients into the hospital, as emergency departments are full of patients waiting for an available bed. Some patients have had elective procedures postponed due to overcrowding.

Elective procedures are often the most profitable for hospitals, and delays scheduling them can hurt revenue. Hospitals are also the most expensive place for a person to receive care, and for hospitals committed to caring for patients on a predetermined reimbursement, additional time in the hospital can eat into that payment.

"That patient doesn't need to be there anymore and is probably being harmed," said David E. Williams, president of the consulting firm Health Business Group. "If you're in the hospital, you're more likely to get an infection. It's more costly. And the patient who needs to get into that bed can't."

A variety of factors — in many cases exacerbated by the pandemic — are preventing hospitals from discharging patients more quickly. The new MHA report cites insurance delays and denials as the No. 1 barrier, followed by staffing shortages at nursing homes and rehabilitation centers.

It's worth noting that COVID isn't responsible for the overcrowding; however, hospital capacity is part of the state's COVID data, and the impact of the discharge backlog is visible. Last week's report showed that only around 6.4% of the state's 8,715 non-ICU hospital beds were available for new patients. Actually discharging all the folks who are stuck in hospital waiting for discharge would nearly quadruple the number of available beds. Alas, there's no single easy fix.