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Correspondence to Arifeen Sylvanna Rahman, School of Medicine, Stanford University, Stanford, CA 94305, USA; [email protected]
Introduction
Reducing unnecessarily prolonged hospitalisations has long been identified as an area for improving quality of care, improved hospital efficiency and reducing healthcare costs.1–3 Reduction in length of stay has been speculated to contribute to a reduction in risk of hospital-associated adverse events and a reduction in healthcare costs for patients and hospitals.4 At the same time, there has been concern to ensure that early discharge or reduction in length of stay does not decrease quality of patient care and increase readmission risk.2 5
However, many patients have increased length of stay due to reasons outside of necessary medical care. Previous studies have explored patient and social factors prolonging length of stay that hospital systems cannot control, such as access to discharge facilities.6–8 While many delays relate to patient readiness or lack of safe discharge plan, system barriers such as delays in subspecialty consultation and procedures have also been shown to increase the length of stay.7 9
Consultation delays and length of stay have been studied in several contexts in the hospital setting. Departments including emergency room, palliative care, endocrinology, psychiatry and social work have explored the effect of early consultation on target patients and length of stay.10–14 However, limited data exist on consultation delays in internal medicine. System barriers from the hospital, including delays in subspecialty consultations or procedures, have been suggested.6 8 9 However, previous studies did not explore reasons for delay or evaluate specific specialties causing delays. We are the first to categorise and describe reasons behind consultation and procedure delays in an inpatient internal medicine setting.
Methods
Design
This was a prospective study conducted over 8 weeks from 11 October 2017 to 29 November 2017.
Setting
The study was conducted on the general internal medicine service at Stanford Hospital, a tertiary-care hospital with 444 patient beds. The general internal medicine service is comprised of five distinct teams and does not cover patients admitted to specialised cardiology, pulmonology, haematology, oncology or transplant wards. We conducted weekly audits every Wednesday on admitted patients on the five teams of the Internal Medicine service. In the afternoon, internal medicine teams regroup for rounds...