Design: Multicentre cross-sectional single-day survey
Population: 1348 general medicine inpatients in 21 US veterans' hospitals
Primary outcome: Proportion medically ready for discharge and with delays of a week or more
Effect: 41.9% ready for discharge; 18.1% ready for 1 week or longer

This cross-sectional study surveyed attending physicians on general medicine wards in 21 US veterans' hospitals on a single day, covering 1348 inpatients. It asked who was medically ready for discharge and what was holding them.

41.9% were medically ready to leave, and 18.1% had been ready for at least a week. More than half of those with long delays were waiting for a nursing home or assisted living place. The commonest needs were help with daily activities and geriatric psychiatric care; the commonest holds were funding and choice of destination. The proportion varied widely between hospitals, from none to about a third.

The health system is different from India's, where long-term care beds are scarce and families carry most care. But the pattern is familiar: delay usually comes from what happens after discharge, not from medicine. A patient who stays a week longer than needed is exposed to falls, delirium, infection and deconditioning.

Ask on admission who will care for the patient at home and whether they can.
Identify patients likely to need placement or home support in the first 48 hours.
Involve social work and family early for patients who cannot manage daily activities.
Mobilise patients waiting for discharge to limit deconditioning.

Why it matters

Days spent waiting for a bed elsewhere are days of avoidable inpatient harm.

The statistics, in plain English

This is a one-day snapshot of physician judgement, not a measure of outcomes. The wide range between hospitals (0% to 32% with long delays) suggests local processes matter, but the study cannot show which ones.