SHM Converge Scientific Abstract ePoster Gallery-Current State Assessment of the Inpatient Guardianship Process

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This retrospective study examined 2022 hospitalizations involving inpatient guardianship applications across three University of Washington Medicine sites: Harborview Medical Center (a level one safety-net hospital), a tertiary referral center, and a community hospital.<br /><br />The authors found 99 guardianship applications, with the majority (82) at Harborview. These cases were associated with long, costly, and clinically complex hospital stays. Many patients were transferred from other hospitals or came from outside the county, suggesting that guardianship needs often arise in medically and socially complicated situations.<br /><br />At the safety-net hospital, the patient group had distinctive social and demographic characteristics: more were younger, male, Spanish-speaking, experiencing homelessness, and insured by Medicaid. Harborview also had higher rates of healthcare-associated complications and restraint use, indicating greater harm during prolonged hospitalization. Disposition and discharge outcomes were heavily influenced by limited internal placement options and the availability of adult family homes.<br /><br />The study concludes that patients needing inpatient guardianship are a vulnerable population at risk for prolonged hospitalization, increased expense, and patient harm. Safety-net hospitals bear a disproportionate share of this burden, both in number of patients and total patient-days. The authors emphasize the need for intensive interdisciplinary coordination, better resource allocation, and upstream interventions to identify and support patients at risk of losing decisional capacity before hospitalization becomes prolonged and harmful.

Asset Subtitle

Molly Rosenthal

Meta Tag

Author List Julie Pham, Lauge Sokol-Hessner, Miriam Levy, Molly Rosenthal

Category Research

Concept Inpatient Guardianship

Concept Hospital Length of Stay

Concept Healthcare Cost

Concept Patient-Day Burden

Concept Demographic Factor

Distinguished Non-Finalist

Presenter Organization Harborview Medical Center, University of Washington Medicine

Presenting Author Molly Rosenthal

Track Quality Improvement

Keywords

inpatient guardianship

hospitalization

safety-net hospital

prolonged stay

vulnerable patients

medicaid

homelessness

restraint use

healthcare-associated complications

discharge disposition

Inpatient Guardianship

Hospital Length of Stay

Healthcare Cost

Patient-Day Burden

Demographic Factor