6 In recognition of these poor health outcomes, hospitals strive to ensure that patients are discharged in a timely manner once they are deemed medically stable, or fit for discharge, that is, once the medical decision has been made that the patient has completed the required acute care, including all relevant investigations with none further anticipated, and is ready to be discharged from the hospital. 5 In addition, older people’s mobility, muscle strength and aerobic capacity can be adversely affected by just 10 days of bed rest, which, alarmingly, translates into almost 10 years of functional decline. 5 For patients aged 65 or older, length of stay increased the chance of developing geriatric syndromes in hospital, such as pressure ulcers, incontinence, falls, functional decline and delirium independent of physical, cognitive or functional impairment. 4 Deconditioning and loss of mobility are common outcomes for inpatients who are medically fit for discharge but remain in hospital, with older people being particularly at risk.
1–3 A retrospective observational study of over 22 000 patients concluded that patients staying in hospital 14 days or longer suffered increased in-hospital morbidity and mortality. Patients classified as ‘long stay’ in acute hospitals are at risk of poor health outcomes and use up valuable hospital resources.
The longer patients remain in hospital after they are medically ready for discharge, the worse the situation becomes for the patient, their families and for the health system.