BACKGROUND: Delayed discharge is a costly phenomenon that takes place in every hospital system in the country, with significant operational consequences. The purpose of this study was to identify reasons for delayed discharge and evaluate the financial implications at a Level I trauma center. METHODS: Patients admitted to a Level I trauma center from September 2001 through June 2003 were classified with respect to those who did and did not experience a delay in discharge. RESULTS: For every 25 patients admitted to the trauma center, 1 experienced a delay in discharge, with an average delay of 6 days. The majority of the delays in discharge were attributable to difficulties in patient placement, such as lack of a rehabilitation or subacute hospital bed. Total hospital charges for excess days in the hospital for patients experiencing a delay in discharge were $2,455,703 per year and total costs were $715,403 per year. Patients with delayed discharge tended to be older, female, more severely injured, and more likely to have government-sponsored insurance. CONCLUSION: This study suggests that the main cause of delayed discharge from trauma centers is a consequence of limitations in posthospital care. Strategies must be identified to reduce the barriers to posthospital care to reduce these delays in discharge, lower unnecessary hospital costs, and ensure the financial viability of trauma centers and continuation of clinical services to the communities they serve.