Caregiver perceptions of the reasons for delayed hospital discharge.

CONTEXT Financial pressures have increased the emphasis on expeditious hospital discharge. Identification of barriers to timely discharge may help direct efforts to decrease unnecessary hospital days. OBJECTIVE To identify caregivers' perceptions of reasons for discharge delays at an academic medical center. DESIGN Survey and free-form written responses using a convenience sample (overall response rate, 68%). RESPONDENTS 104 housestaff, 34 attending physicians, and 33 nurses. RESULTS Nurses were much more likely than housestaff or attending physicians to cite inadequate communication as a reason for discharge delays. Nurses were also more likely to attribute delays to rounds and other conferences (48% vs. 22% and 9%, respectively; P = 0.05). Physicians, however, were more likely to cite delays in testing and availability of subacute care beds. Almost all housestaff and attendings thought that discharge decisions were generally made in the morning, and over 60% felt that discharge orders were usually written before noon. In contrast, none of the nurses thought that orders were usually written before noon. CONCLUSIONS Caregivers at the same institution perceived different barriers to discharge and believed that discharge-related activities occurred at different times. To facilitate hospital discharge, communication gaps should be addressed and traditional morning routines should be reexamined.