SHM Converge Scientific Abstract ePoster Gallery-Prolonged Lengths of Stay Beyond Medical Necessity: Characterization of Outcomes, Barriers, and Cost

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This retrospective study examined prolonged hospital stays beyond medical necessity in an urban academic teaching hospital. Researchers reviewed discharges from nine general medicine floors between January 2018 and August 2021, focusing on admissions that lasted at least 60 days before the COVID-19 pandemic. Out of 39,776 discharges, 354 admissions (0.9%) reached 60 days, and 109 outlier admissions from 2019 were analyzed in detail.<br /><br />The patient group was medically and socially vulnerable. The median age was 64 years; 57.8% were male. Common comorbidities included mental health disorders (71.6%), substance use disorders (29.4%), ventilator or tracheostomy dependence (25.7%), dialysis dependence (11.9%), and homelessness (5.5%). About one-third of patients had conservatorship applied for during admission, and 11% were already conserved.<br /><br />These prolonged stays were very costly and clinically significant. Average length of stay was 97.4 days, compared with 7.3 days for typical admissions. The average charge per stay was $836,062, with some exceeding $4 million. The most common primary diagnosis was sepsis, and in-hospital mortality was 5.5%.<br /><br />Discharge delays were often caused by nonmedical barriers, especially after the first 60 days. At day 60, 55% of barriers were nonmedical and 39% medical; by day 120, 77% were nonmedical. The most common nonmedical issue was difficulty finding an accepting post-acute facility, followed by insurance problems, discharge planning challenges, conservatorship issues, and communication barriers with family or guardians.<br /><br />The study concludes that prolonged hospitalizations beyond medical necessity disproportionately affect vulnerable patients and are driven largely by nonmedical discharge barriers, creating substantial system-level costs and potential harm.

Asset Subtitle

Lucy Gao

Meta Tag

Author List Gretchen Berland, Lucy Gao

Category Research

Concept Prolonged Hospitalization

Concept Non-medical Barrier

Concept Clinical Risk Factor

Concept Facility Placement

Concept Mortality

Distinguished Non-Finalist

Presenter Organization Yale School of Medicine

Presenting Author Lucy Gao

Track Transitions of Care

Keywords

prolonged hospitalization

medical necessity

urban academic hospital

discharge barriers

nonmedical barriers

vulnerable patients

length of stay

post-acute facility

conservatorship

hospital costs

Prolonged Hospitalization

Non-medical Barrier

Clinical Risk Factor

Facility Placement

Mortality