NONMEDICAL BED-DAYS FOR STROKE PATIENTS ADMITTED TO ACUTE-CARE HOSPITALS IN MONTREAL, CANADA

Background and Purpose Reducing the amount of nonoptimal time stroke p atients spend in the hospital should be a priority because prolonged h ospitalization is not only costly but may be detrimental for persons w ith stroke through deconditioning, social isolation, and the fostering of dependent relationships. The purpose of this study was to determin e the amount of time spent by stroke patients in acute-care hospitals that was not justified for medical reasons and to identify mechanisms contributing to nonmedical bed-days. Methods A retrospective cohort st udy was performed with 2232 persons admitted for acute stroke to one o f 13 hospitals in Montreal, Canada, during 1991. Information was colle cted on the patient, the stroke, functional status, course in hospital , services, and discharge. Nonmedical bed-days were calculated as the difference between the time to meet specified criteria and time of dis charge. Associations with nonmedical bed-days were estimated with adju stment for patient mix. Results Acute-care stay averaged 27 days, yiel ding 60 279 bed-days. Almost 50% of the cohort remained in the hospita l after meeting criteria for medical discharge, resulting in 43% of to tal bed-days not accounted for medically. Fifty percent of persons wit h delayed discharge did not go home but were discharged to another acu te-care hospital or to rehabilitation or long-term care, accounting fo r 66% of the nonmedical bed-days. Hospital and discharge destination r emained strongly associated with nonmedical days, even after adjustmen t for patient mix. Conclusions The single greatest contributor to exce ssive nonmedical stay appeared to be the need in Quebec for increased access to alternate levels of care, including skilled nursing faciliti es and rehabilitation centers.