One of the reasons for delayed inpatient discharges is no one is availble to transport the patient home or to the next stop (e.g., rehab or skilled nursing facility). Some hospitals have developed "discharge lounges" where discharge patients await transport, but this is simply another symptom of waste in the system.

I think there will always be waste in this system, even as someone who is skilled at thinking about discharge needs upon admission. Situations change all the time, even up to discharge.

Excellent article.  You might be interested in how Robert Wood Johnson University Hospital Hamilton addressed this problem in the late 1990s and found about the same root causes.  They addressed them effectively and evolved into a best-in-class ED operation.  Details may be found in the case study in my 2008 book Benchmarking for Hospitals published by ASQ Quality Press but currently out of print.  The case study may be available on the ASQ web site. 

Hello Akhilesh,

Excellent article that opens up a pandora's box for the most needed services, It is hard to get into emergency room unless you arrive by an ambulance. People with severe pains are waiting in the front room for various reasons.

Looking at the process and services will help alleviate some of the shortfalls int eh service.

I am an Anesthesiologist and have worked in several acute care settings in various hospitals, both community and tertiary care centers. 

While the first point about the ER facing a backlog because of non availability of beds is absolutely true, the same being true for beds being occupied in the Post Anesthesia Care Unit because of a lack of floor beds or beds of appropriate acuity, line an ICU bed or a monitored bed, the real reason for the lack of flow being a healthcare space that is fragmented by different entities to which patients belong, like one HMO vs a Medicaid patient vs Medicare or even a homeless patient. That's what is the real challenge of patient placement for discharge or further care.

To top it off, one also has false( not clinically substantiated criteria) about patient discharge or placement.

Let's assume that patients could go freely to any level or facility of care, a lot of bottlenecks would abate, barring for discharge to home or to the street!

One could make that an argument for a single payer system but underinvestment in single payer systems(NHS) or disguised " largely single payer" systems such as ours will nearly have the same outcome. 

That's why in CA, with a very large MediCaid and Medicare population will continue to see poorer healthcare outcomes, not only from waiting but also from the removal of physicians progressively from the healthcare chain, who could make speedy decisions based on knowledge and experience. Today, as we all know, ERs pretty much have become a one Physician and multiple physician extender models, further impounding delays even at the ER level.

Till such time we have transparency in health care pricing with prices that are competitive and no cost shifting from government programs to private insurance, we will continue to suffer delays and denials in care, right from the ER to rehab.

All hospitals have some form of bottleneck due to staffing and room availability.  During a recent visit to my regional hospital, the availability of a doctor led to a long wait due to an emergency room overload.  It seems the hospital had a capacity problem with insufficient staffing that had to attend to patients in the main hospital.