Delays in Patient Discharges Straining Hospitals

No one wants to be a hospital patient. No matter how good the food, how nice the rooms or how great the care and service, it’s still a hospital, and most people would rather be anywhere else. 

Fortunately, today’s hospital care is rarely about long-term stays; many patients can be admitted, cared for and discharged in a matter of days. Yet a growing number of hospital patients, despite being ready for discharge, must stay in the hospital for weeks, months or even years. 

These patients are no longer sick enough to require acute care and not well enough to be on their own. They find themselves stranded in a hospital room they no longer need because they can’t get to the type of care or support they do need. 

These patients are no longer sick enough to require acute care and not well enough to be on their own. They find themselves stranded in a hospital room they no longer need because they can’t get to the type of care or support they do need. 

“I felt lost sometimes,” says Leiona Brown, a Scripps patient who was cleared for discharge from the hospital just a few days after she was admitted, but spent more than 100 days there, waiting for a bed in a local skilled nursing facility. 

“It was hard because everyone around me knew I was ready for physical therapy,” says Brown. “They knew I wanted to move on and progress even more, so they were constantly on the phones trying to get me placed.” 

“These are patients who have been treated for their injury or illness, but still can’t take care of themselves,” says Melody Thomas, director of patient care and case management at Scripps Mercy Hospital. 

“Like Leiona — who needed intense physical therapy and daily life assistance — these patients usually need the kind of care a skilled nursing facility, behavioral health center or other residential treatment center can provide. But we often can’t find a facility that is able or willing to take them.” 

Long-term discharge delays, or “avoidable bed days” as they’re called in hospitals, are not a new problem in health care, but the volume of cases has risen significantly, along with the complexity of safely transitioning some patients to more appropriate levels of care. This increased volume is having a big impact on health care access. Caring for nonacute patients in acute care hospital beds leaves fewer beds available for patients who need them. 

The California Hospital Association reported last year that in San Diego and Imperial counties, the number of patients awaiting placement in a skilled-nursing facility had more than doubled since the beginning of the pandemic. And that number is still rising. 

This year, Scripps saw more than 3,200 patients spend over 27,200 avoidable bed days at its five hospital campuses, up from around 10,000 days just three years ago. 

In November 2023, there were 22 “medically stable to discharge” patients who had been at Scripps hospitals for more than 30 days without a suitable discharge plan, three of whom have been in the hospital for more than 500 days and one twice that long.

“It’s a frustrating circle formed by an overall broken health care system. Someone can’t access the specialized care they need so they end up in the hospital, and we care for their immediate concerns. Then they can get stuck for months or sometimes years because it’s even hard for us to get them to the ongoing care they need.” 

“Our longest patient has been with us for more than three years,” confirms Chris Van Gorder, Scripps president and CEO. “The patient is on the waitlist for the state psychiatric hospital in San Luis Obispo, but open beds for transfers are extremely rare, and other transfers have a higher priority than hospitals. 

“When it comes to behavioral health and psychiatric care, it’s hard to come by in California and even harder in San Diego,” Van Gorder adds. “San Diego needs around 1,700 inpatient behavioral health beds, but the region has less than half that number, and there are even fewer long-term behavioral health beds.” 

Many of the already limited number of San Diego skilled nursing, long-term care and other step-down care alternatives are already at capacity. And with the rising cost of staff and care, those that have openings are reluctant to accept higher-need patients who have lower paying health coverage like MediCal or Medicare. 

“It’s a frustrating circle formed by an overall broken health care system,” says Van Gorder. “Someone can’t access the specialized care they need so they end up in the hospital, and we care for their immediate concerns. Then they can get stuck for months or sometimes years because it’s even hard for us to get them to the ongoing care they need.” 

This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.