Medically ready for discharge: A multicenter Veterans Health Administration assessment of hospitalized patients

BACKGROUND: Patients may remain hospitalized despite being medically ready for discharge, some for prolonged periods. Delays in discharge may negatively impact patients and hospitals. OBJECTIVE: To quantify the proportion of acute care general medicine patients in VHA hospitals who are medically ready for discharge but remain hospitalized due to major discharge barriers and to identify the major contributors. METHODS: Cross-sectional study of 21 VHA hospitals using a structured tool to collect data from inpatient medicine attending physicians about their patients and the hospital on a single day. Primary outcomes were the percentage of patients medically ready for discharge and those with "major discharge barriers" (medically ready for discharge ≥1 week). Secondary outcomes explored support needs, resources awaited, and major contributing factors. RESULTS: Of 1,348 sampled patients, 41.9% (n = 565, range 18.4%-64.7%) were medically ready for discharge, including 18.1% (n = 244, range 0%-32%) who had major discharge barriers. For more than half of these patients, the intended discharge location was a long-term care facility (41.9%, nursing home for custodial care; 9.7%, assisted living facility). The most identified support needs were assistance with ADLs and geriatric-psychiatric care. Payor source and selection of discharge location were the most common resources awaited. CONCLUSIONS: Nearly one in five hospitalized veterans had major discharge barriers leading to prolonged hospitalization after they were medically ready for discharge. More than half were awaiting long-term care placement. This was due to a lack of available post-discharge resources and support. Multidisciplinary engagement to streamline processes and increase resources for post-discharge facility placement is needed.

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Publication Details

Journal
Journal of Hospital Medicine
Published
2026-10-15
DOI
https://doi.org/10.1002/jhm.70511
Primary Topic
Hospital Admissions and Outcomes
Type
article
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article

Medically ready for discharge: A multicenter Veterans Health Administration assessment of hospitalized patients

Cherinne Arundel, Megha Garg, Michelle M. Guidry, Heather S. Shaw et al.
Journal of Hospital Medicine
Hospital Admissions and Outcomes
article

Medically ready for discharge: A multicenter Veterans Health Administration assessment of hospitalized patients

Cherinne Arundel, Megha Garg, Michelle M. Guidry, Heather S. Shaw, David Malinak, Andrea C. Smeraglio, Nazima Allaudeen, Emily E Cantor, Albertine S. Beard, LeeAnn M. Cox, Matthew Tuck, Amanda Medley Raines, Maralyssa A. Bann, Paul W. Helgerson, Nurit Harari, Craig G. Gunderson, Paul B. Cornia, Nicholas Meo, Elizabeth A. Schackmann, Samantha Spilman, Casey Kaneshiro, Daniel B. Heppe, Raj Sehgal, Dustin J. Uhlenhopp, Matthew V. Ronan, William Turbyfill, Jessica Cyr, Joyce A Akwe, Nathan Baskin, Ashley H. Sweeney, James Darrell Laudate
article en

Abstract

BACKGROUND: Patients may remain hospitalized despite being medically ready for discharge, some for prolonged periods. Delays in discharge may negatively impact patients and hospitals. OBJECTIVE: To quantify the proportion of acute care general medicine patients in VHA hospitals who are medically ready for discharge but remain hospitalized due to major discharge barriers and to identify the major contributors. METHODS: Cross-sectional study of 21 VHA hospitals using a structured tool to collect data from inpatient medicine attending physicians about their patients and the hospital on a single day. Primary outcomes were the percentage of patients medically ready for discharge and those with "major discharge barriers" (medically ready for discharge ≥1 week). Secondary outcomes explored support needs, resources awaited, and major contributing factors. RESULTS: Of 1,348 sampled patients, 41.9% (n = 565, range 18.4%-64.7%) were medically ready for discharge, including 18.1% (n = 244, range 0%-32%) who had major discharge barriers. For more than half of these patients, the intended discharge location was a long-term care facility (41.9%, nursing home for custodial care; 9.7%, assisted living facility). The most identified support needs were assistance with ADLs and geriatric-psychiatric care. Payor source and selection of discharge location were the most common resources awaited. CONCLUSIONS: Nearly one in five hospitalized veterans had major discharge barriers leading to prolonged hospitalization after they were medically ready for discharge. More than half were awaiting long-term care placement. This was due to a lack of available post-discharge resources and support. Multidisciplinary engagement to streamline processes and increase resources for post-discharge facility placement is needed.

Journal of Hospital Medicine
Dartmouth College (US), Tulane University (US), University of Colorado Hospital (US), Nebraska Medical Center (US), San Francisco VA Medical Center (US), University of New Mexico Hospital (US), Harvard University (US), Emory University (US), University of San Diego (US), University of California, Los Angeles (US), University of Pittsburgh (US), Palo Alto University (US), University of California, San Francisco (US), Georgetown University (US), George Washington University (US), University of Washington (US), VA Palo Alto Health Care System (US), Veterans Health Administration (US), UC San Diego Health System (US), VA Boston Healthcare System (US), Yale University (US), University of California San Diego (US), VA Connecticut Healthcare System (US), Boise VA Medical Center (US), VA Puget Sound Health Care System (US), VA San Diego Healthcare System (US), Richard L. Roudebush VA Medical Center (US), Minneapolis VA Health Care System (US), White River Junction VA Medical Center (US), Durham VA Health Care System (US), VA Pittsburgh Healthcare System (US), Southeast Louisiana Veterans Health Care System (US), University of Minnesota Medical Center (US), Oregon Health and Science University Hospital (US), South Texas Veterans Health Care System (US), VA Portland Health Care System (US), VA Eastern Colorado Health Care System (US), Atlanta VA Health Care System (US), Duke University Hospital (US), New Mexico VA Health Care System (US), VA Nebraska Western Iowa Health Care System (US), VA Greater Los Angeles Healthcare System (US), Indiana University School of Medicine, University of Virginia (US), Indiana University – Purdue University Indianapolis (US), University of Nebraska Medical Center (US), University of San Francisco (US), University of Colorado Denver (US)
Good health and well-being
Openalex Percentile: Top 10%
Hospital Admissions and Outcomes
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