Breaking the Bottleneck: Delayed Discharges and Their Operational Implications for Healthcare Efficiency in a Small European Acute General Hospital

Delayed discharge represents a persistent challenge in healthcare systems, contributing to inefficiencies in hospital bed utilization, increased costs, and reduced patient flow. In small and centralized healthcare systems, these effects may be further amplified due to limited post-acute care capacity and restricted patient redistribution. This study quantified the prevalence of inappropriate hospital days as a proxy for delayed discharge and examined their relationship with patient demographics, medical specialty, and associated costs in an acute general hospital. A quantitative analysis of 220 medical records was conducted using a modified Appropriateness Evaluation Protocol (AEP). Descriptive statistics and non-parametric tests were applied to identify significant associations between inappropriate hospital days and selected variables. According to the findings, within this intentionally enriched sample of patients with a length of stay exceeding seven days in the selected wards, nearly half of all accumulated inpatient bed days failed to meet acute necessity criteria, with the vast majority of these service backlogs stemming from placement delays in downstream rehabilitation facilities and long-term care institutions. Within this high-risk cohort, inappropriate hospital days, used here as a proxy for delayed discharge, were more common among older patients and among medical specialties than in other specialties, while no consistent relationship was observed with gender. Cost analysis (carried out over a three-month period) indicated an order-of-magnitude estimate of the acute bed day resources associated with inappropriate hospital days in the units studied. These findings are consistent with the interpretation that inappropriate hospital days, used here as a proxy indicator of delayed discharge, may be influenced by a combination of external capacity constraints and internal operational inefficiencies, although causality cannot be established from this observational design. While the findings cannot be generalised to the entire inpatient population or health system, within this intentionally enriched cohort of long stay inpatients the study highlights the need to strengthen post-acute care provision, improve discharge coordination processes, and enhance system integration to optimise hospital efficiency and patient flow in similar operational contexts.