Prolonged Hospital Stays, and Their Impact On Health Care Resources

By Lakmali Ranathunga, MD, chief medical officer, Miami Valley Hospital North, Upper Valley Medical Center

Extended hospital stays profoundly impact health care resources, affecting various aspects of patient care and resource allocation. Each day, we encounter patients who remain hospitalized for extended periods despite achieving medical stability. This demographic comprises individuals awaiting guardianship arrangements, insurance approvals, or financial assistance. Many await specialized therapies and psychiatric services or require assistance with decision-making and financial planning for discharge. The reasons for these prolonged stays are multifaceted, encompassing legal, economic, behavioral, and medical capacity issues, as well as international relations.

These patients represent avoidable hospitalizations that strain resources, tying up beds that could serve acutely ill patients. Such prolonged stays lead to inefficiencies in resource utilization, equipment, staffing, provider time, and increased nursing and ancillary care demands. While protocols exist to mitigate resource utilization, opportunities remain to streamline processes, reduce unnecessary lab work and monitoring, and optimize discharge planning.

Research indicates that a significant portion of hospital days—up to 14%—are attributed to these patients, with some cases extending stays by more than 30 days, incurring substantial costs and increasing the risk of hospital-acquired infections. On a global scale, addressing this issue is paramount.

Effective strategies involve establishing complex discharge teams comprising medical, legal assistants, respite care providers, skilled nursing professionals, and community resources. These teams focus on the early identification and screening of vulnerable patients, engaging in regular interdisciplinary discussions, and garnering support from leadership and diverse stakeholders. Some health care systems have implemented medical respite care organizations and forged partnerships with skilled nursing facilities to address the needs of this vulnerable patient population.

In conclusion, addressing prolonged hospital stays requires a multifaceted approach integrating specialized care, interdisciplinary collaboration, and community partnerships to optimize resource utilization and enhance patient outcomes.

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