SHM Converge Scientific Abstract ePoster Gallery-Deciphering Prolonged Length of Stay: An Academic Hospitalist Service Experience

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This study examined why hospitalized patients on an academic hospital medicine service experienced prolonged lengths of stay. The authors reviewed all eligible inpatient encounters in fiscal year 2021, excluded observation and COVID-19 cases, and then analyzed a stratified random 5% sample (190 encounters) using a standardized day-by-day chart review tool. The sample closely matched the full eligible population in demographics and outcomes.<br /><br />Across 1,152 patient-days reviewed, 343 days (29.8%) included a care delay. Delays were grouped into five main categories: system, discharge, provider, patient/family, and consultant-related delays. System delays were the most common (32.9% of all delays), followed by discharge delays (27.7%) and provider delays (19.2%). Patient/family and consultant delays were less frequent.<br /><br />Within system delays, the biggest contributors were delays in procedures and imaging studies, including weekend-related delays. Discharge delays were dominated by difficulty securing placement in post-acute care facilities, especially waiting for beds or authorization. Provider delays were comparatively uncommon and were mainly due to slow progression of care. <br /><br />The study also found that delays were more often driven by system-level and discharge-process issues than by primary medical providers. The authors conclude that identifying these patterns can help hospitals target interventions toward procedure/imaging throughput and discharge placement processes to reduce avoidable length of stay and associated costs.

Asset Subtitle

Adam Nadler

Meta Tag

Author List Adam Nadler, Flora Kisuule, Melinda Kantsiper, Shaker Eid, Venkat Gundareddy

Category Research

Concept Length of Stay

Concept Prolonged Hospitalization

Concept Care Delay

Concept System Delay

Concept Discharge Delay

Distinguished Non-Finalist

Presenter Organization Johns Hopkins University School of Medicine

Presenting Author Adam Nadler

Track Quality Improvement

Keywords

prolonged length of stay

hospitalized patients

care delays

system delays

discharge delays

provider delays

post-acute care placement

procedure delays

imaging delays

academic hospital medicine

Length of Stay

Prolonged Hospitalization

Care Delay

System Delay

Discharge Delay