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Discharge Delays for Patients Requiring In-Hospital Guardianship: A Cohort Analysis

Jasper J Chen, Christine T Finn, Karen Homa

    Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality
    |June 5, 2015
    PubMed
    Abstract

    Insights

    Nonclinical factors significantly delay hospital discharge for guardianship patients, costing millions. Addressing these delays, such as awaiting long-term care approval, is crucial for efficient patient flow and hospital revenue.

    Area of Science:

    • Healthcare Management
    • Health Services Research
    • Geriatric Medicine

    Background:

    • Guardianship patients often face complex discharge processes.
    • Delays in hospital discharge impact patient care and hospital resources.

    Purpose of the Study:

    • To identify and assess nonclinical factors contributing to delayed hospital discharge for patients under guardianship.
    • To quantify the impact of these delays on hospital revenue.

    Main Methods:

    • Retrospective cohort study analyzing 3 years of utilization review data.
    • Mann-Whitney test used to compare medically unnecessary days (MUD) between delayed and non-delayed guardianship patients.

    Main Results:

    • The median number of MUD was 19.5 days.
    • 14 of 48 patients experienced significant delays (median 63 MUD), primarily due to long-term care Medicaid approval (50%), insurance pending (21%), or social/transportation issues (21%).
    • These delays represented a potential net revenue loss of $5.5 million.

    Conclusions:

    • Nonclinical discharge delays for guardianship patients are substantial and costly.
    • These delays are potentially unavoidable and necessitate policy exploration for mitigation.
    • Improving discharge processes for this population is essential for operational efficiency and financial health.

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