What drives prolonged hospital stays in schizophrenia-spectrum disorders? A Canadian tertiary care review

Schizophrenia imposes significant economic and social burdens, often resulting in prolonged inpatient length of stay (LOS), particularly for treatment-resistant cases. This study aimed to identify clinical, demographic, and social factors associated with prolonged LOS in a Canadian tertiary schizophrenia inpatient unit to highlight modifiable drivers and inform targeted interventions.

A retrospective chart review of 120 consecutive discharges from January 2021 to May 2023 was conducted. Data on demographics, clinical history, and discharge delays were analyzed using ANOVA and t-tests to identify factors associated with prolonged LOS. Prolonged LOS was examined while differentiating between discharge delays and extended hospital stays.

The mean LOS was 200.43 days (SD = 285.67, median = 100 days). Fifty percent of patients (n = 60) experienced discharge delays, defined as >10 days between readiness and actual discharge. Housing instability was the leading cause (56.67%, n = 34), including patients seeking housing (40%) or awaiting long-term care (16.67%). Longer illness duration (p = 0.048) and treatment-resistant schizophrenia (TRS, indicated by clozapine use; p = 0.011) were significantly associated with length of delayed discharge. Sex, relationship status, and family or community support were not significantly associated with length of delayed discharge. Illness complexity/severity was the primary reason for extended hospital stay in all cases (100%, n = 12).

This exploratory study highlights distinct clinical and system-level contributors to prolonged hospitalization. Housing instability, chronic illness, and TRS are key contributors to delays in discharge. Early discharge planning, enhanced housing support, and specialized TRS care pathways are essential to reduce LOS and optimize inpatient care.