- Design
- Multicentre cross-sectional survey on a single day
- Population
- 1348 general medicine inpatients in 21 VA hospitals
- Primary outcome
- Proportion medically ready for discharge and delayed ≥1 week
- Effect
- 41.9% ready; 18.1% with major discharge barriers
A one-day cross-sectional survey across 21 US Veterans Affairs hospitals asked attending physicians about 1348 general medicine inpatients. Published in the Journal of Hospital Medicine on 15 October 2026.
42% were medically ready for discharge, and 18% had been ready for a week or longer. For more than half of this delayed group, the planned destination was long-term care, mainly nursing homes. The commonest needs were help with daily activities and geriatric psychiatric care; the commonest hold-ups were funding and choosing a facility.
Prolonged stays after medical readiness expose older patients to deconditioning, delirium and hospital infection. The bottleneck lies outside the ward, but much of the groundwork can start on day one.
This is a single-day snapshot of one US health system, judged by physicians rather than measured, so the numbers will differ elsewhere.
- Ask about home support and likely discharge destination at admission, not when medically fit
- Refer early to social work for patients likely to need placement
- Keep patients mobile while they wait to limit deconditioning
- Screen for delirium daily in patients with long stays after medical readiness
Why it matters
A fifth of medical beds may be holding patients whose medical care is finished.
The statistics, in plain English
The 18% average hides wide variation between hospitals, from none to 32%, which suggests local processes matter as much as patient need.
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