JUSTIFICATION OF HOSPITAL DAYS AND DISCHARGE DELAYS IN A NONSELECTED POPULATION OF ACUTE STROKE PATIENTS

Using a published protocol, we evaluated a non-selected population of stroke patients to identify unnecessary days of hospitalisation in the Department of Neurology at the Centre Hospitalier Universitaire Vaudo is, Lausanne, Switzerland. This study was undertaken to determine whet her physicians can modify the non-medically justified hospital days. W e prospectively studied 118 patients with stroke admitted to our Depar tment over a period of 5 months. Each day spent on the ward was placed in one of two categories: those due to medical reasons (1,391 hospita l days) and those due to non-medical reason (518 days). Using a previo usly published protocol, 74 parameters were evaluated. Delays in obtai ning examinations or a specialist's consultation accounted for a small proportion of waiting days (1.9% of total hospital days), which was g reater in patients who were not disabled (0.9% of hospital days) than in patients with total dependence (0.2% of hospital days). The delays resulted mainly from awaiting transfer either to another department or to a nursing home. The length of stay increased with severity of depe ndence. However, the number of days spent for transfer to a nursing ho me was also relatively high in the non-dependent patient group (42% of hospital days). This study demonstrates that neurologists cannot easi ly influence the length of stay in hospital. It also corroborates the need to develop short- and long-term chronic care facilities to facili tate the transfer of patients once there are no further medical reason s for staying in hospital.