The aim of this study was to analyze the causes of delay in hospital discharge of patients admitted to Neurology service and to provide possible solutions that can guide policy-makers in improving hospital discharge.

We reviewed a total of 565 medical records of patients admitted to Neurology service over a 24-month period. First, a pilot study was used to define the reasons to which delays could be attributed. It is notable that the delays were mainly related to processes that could be improved by interventions by the care teams and managers. Thus, a series of interventions including increasing the frequency of social work rounds and hiring more staff were provided over a 12-month period. The discharge time was compared pre-and post-interventions.

• The overall discharge time was not statistically different pre- and post-interventions as indicated by ANOVA test (P= 0.424); however, when looking at the individual categories, the discharge time decreased by 41.6% from 72 hours to 42 hours before and after hiring more staff (P<0.001). Similarly, for patients who are waiting for additional testing or hospice placement, the discharge time was decreased by 41.7% and 52.2%, respectively (P<0.001) after more frequent rounds and better communications with the social workers.
  

Delays in hospital discharge are multifactorial, it relates to factors at the health-care provider, the patient, the relationship between providers, and the organizational support for care providers. Providers can improve hospital discharge time by streamlining medication reconciliation, well-coordinated care with patients and their family, and direct and timely communication with social work staff. More importantly, investment in human resources is required to enable health-care providers and social work staff to work more closely to improve the patient hospital discharge time.