Measuring and costing delayed discharges: conceptual and methodological challenges

Western societies are experiencing challenging economic times and in the UK the NHS is faced with budget reductions for the first time in decades. In the last few years, media reports of people staying in acute care for too long have proliferated. ‘Bed-blocking’ is the loaded term used to describe patients whose discharge from hospital is not timed with the speed desired by the institution. Synonymous expressions used in different countries and across time have similar meanings despite the contextual differences. ‘Delayed discharges’ is the recommended politically correct expression in the UK at the time of writing. In the 1990s, when the drive for efficiency embedded healthcare institutions, economists established that to maximise productivity in hospitals, patients had to flow through acute care at an average speed. Any deviance from this average is considered a decrease in efficiency and a misuse of public resources. Four interrelated issues challenge this economic theory and research studies such as the one carried out by Hendy et al1 and published in this month's issue of Clinical Medicine illustrates most of them.