DELAYED DISCHARGE OF ELDERLY HOSPITAL PATIENTS - A STUDY OF BED-BLOCKERS IN A HEALTH-CARE DISTRICT IN SWEDEN

With an ageing population an increased pressure on health care resourc es will be seen in most countries. Patients with delayed discharge fro m short-term hospitals, sometimes called ''bed-blockers'', are of spec ial interest in Sweden, especially as liability for payments for these patients has been placed on the municipal authorities by a new reform in 1992. A retrospective study was made of 428 bed-blockers above the age of 64 years from one health district in Uppsala during the two-ye ar period 1987-1988. The median age was 81.6 years, and the majority w ere women. The patients had a median number of diagnoses of 4.1. Addit ional medical events/symptoms were noted in half of the patients after they had been classified as medically ready for discharge. Even thoug h they were classified ''medically ready'' for discharge, they still n eeded care. One-third needed further rehabilitation and another 1/3 fu rther medical attention. Only 1/10 were independent in daily activitie s of living. At the final discharge 1/3 actually returned home and 16% died on the acute ward. The results clearly demonstrate that these pa tients often still had further medical needs after the application for transfer. One crucial question, that needs discussion, is the vague d efinition of a ''bed-blocker''. Related questions are when and where s hould these patients be transferred, as well as the relevance of the t erm ''bed-blocker'' from ethical perspectives.