Hospital Medicine has contributed to improvements in patient throughput with associated reductions in hospital length of stay (LOS). Despite overall downward LOS trends, a small group of outliers continue to have long LOS. A better understanding of the characteristics of the long LOS patient population may promote strategies to improve the care and reduce LOS in this subgroup of patients.
A retrospective chart review of the 248 discharged long LOS patients (defined as greater than 15 day LOS) was conducted for patients of the Department of Medicine Hospital Medicine Service at its’ two tertiary hospitals for the first seven months of 2011. Data gathered included: source of patient to the hospitalist service, discharge disposition, presence of associated neuropsychiatric and legal/guardianship issues, involvement of palliative care consultants, and any other documented issues contributing to long LOS.
The average LOS for the 248 patients was 34 days. This subgroup represented 3.6% of total discharges and 67% of the excess days for our Hospital Medicine Service during the sevenmonth time frame. 173/248 (69.8%) of patients were admitted to the Hospital Medicine Service through the ED, with the majority of these (132/173=76.3%) coming from home. 75/248 (30.2%) were transferred from another hospital service, most commonly the MICU (40/75=53.3%). 115/248 (46%) were discharged to a nursing home or rehab facility, and the same percentage was discharged to home. The remainder (18/148=7.3%) expired, or were transferred to a Hospice or ventilator facility. There were associated neuropsychiatric issues in 63/248 (25%), including dementia, delirium, encephalopathy, intoxication/withdrawal, psychosis and metastatic disease to the brain. Legal/guardianship issues were noted in 3/248 (1.2%). Palliative care consultants were engaged in 47/248 (19%). In 70/248 (28%) there was chart documentation that delays in medical decisionmaking regarding the goals of care contributed to the LOS.
Although representing only a small percentage of total cases, long LOS patients contributed the majority of excess days for our Hospital Medicine Service. Compared to our total patient population, this subgroup of patients had a disproportionately higher number of neuropsychiatric diagnoses. They were also medically complex, as evidenced by the large percentage transferred from other services, most usually the MICU, and discharged to a facility. The care of the long LOS patients also involved endoflife issues, as judged by the percentage with palliative care consultation and documented delays due to goalsofcare decisions. Further study is needed to prospectively validate the characteristics of patients destined for long LOS and the interventions needed to successfully reduce the LOS in this subgroup.
To cite this abstract:Barnett B, Karlin C, Rosenberg D, Gottridge J, Belletti L, Zeitoun N, Kalra S. Characteristics of Patient Population with Long Length of Stay. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97676. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/characteristics-of-patient-population-with-long-length-of-stay/. Accessed April 4, 2020.