Deliberately multidisciplinary why we need new visions for the usual problems

26 de September de 2019

Frequently in the Spanish hospitals, the personnel in charge of the patients who enter the hospital find difficulties at the time of discharge, which extend the stay and are not due to clinical complications but to family or social factors. Generally, the patients, already older and in need of help in their self-care, need to adapt their family life or environment, staying additional days of hospital stay. Known for different terms, such as bed-blocking, high delayed, long stay, etc., it is a problem widely studied in health systems such as the British, but little in our country.

In a recent publication of the “International Journal of Environmental Research and Public Health” the results of a study carried out at the Marqués de Valdecilla University Hospital (HUMV), on cases of delayed discharge in the period between 2007 and 2015.

The study, which won the Valdecilla Nursing Research Award in the 2016 call, funded by IDIVAL, was carried out by a multidisciplinary team of clinical professionals, economists, lawyers and managers from Asturias and Cantabria. The authors wanted to describe the impact of the phenomenon in Cantabria, relating the prolongation of the stay with the patient's own factors such as age, gender or problem by which he enters and also with issues related to the organization of care. In addition, progression has been observed throughout the study period, coinciding with the implementation of the dependent care system and the recent economic crisis.

According to the results of the study, 3015 cases of delayed discharge in the HUMV have been found in those years. The total stays in these cases generally triple the usual average hospital stay. Although it is not an exclusive problem for the elderly, it is usually elderly patients, affecting men and women equally. The longest extension of the stay is related to cases of high complexity, which usually require surgical intervention and need a subsequent admission to the hospital in a functional recovery center before returning home or to a definitive residence. Given the progression throughout the study period, after a rebound in 2008, there is a tendency to improve both in fewer cases and in shorter stays. According to the authors, this may reflect the positive effect of the implementation of the system of care for dependents in the region, the impact of the crisis on a greater availability of caregivers or even on the awareness of health care providers towards the efficiency of resources they handle, such as the days of hospital stay.

The study highlights the joint work between different disciplines to investigate a problem that not only generates an economic expense, but also favors a greater risk of complications during those unnecessary days of stay and a suffering for the patient who suffers and their families. In that direction, the work of the research team on the subject will continue.

Pellico-López A, Cantarero D, Fernández-Feito A, Parás-Bravo P, Cayón de las Cuevas J, Paz-Zulueta M. Factors Associated with Bed-Blocking at a University Hospital (Cantabria, Spain) between 2007 and 2015: A Retrospective Observational Study. Int. J. Environ. Res. Public Health. 2019 Sep 9;16 (3304). doi:10.3390/ijerph16183304.