Why is it Difficult to Discharge from Internal Medicine Departments?

Background and Aims The difficult discharge and blocked beds represent the main critical issues in internal medicine departments. The causes of difficult discharge should be understood on the first day of hospitalization to facilitate better planning. The BRASS INDEX (Blaylock Risk Assessment Screening Score) is a valid screening tool for identifying patients at risk of difficult discharge. The BRASS score does not take into account malnutrition and sarcopenia, medical complications that are often related to a longer length of hospitalization or the need for residential care. Material and Methods We correlated the BRASS to the MNA-SF and proposed a new score dedicated to complex patients in Internal Medicine. 86 consecutive patients hospitalized in the Internal Medicine department were enrolled and were assessed with our score within 48 hours of admission. Results Cognitive status and malnutrition represent the main risk factor for difficult discharge. Discussion We believe it is essential to use this new score for Internal Medicine to evaluate the risk of difficult discharge which includes important aspects as malnutrition and cognitive behavioural state. The holistic approach that evaluates social, psychological, cognitive and nutritional aspects is to be considered indispensable.