A Clinical Pathway for Guardianship at Dartmouth-Hitchcock Medical Center

The Burden of Guardianship: A Matched Cohort Study

“…Other studies 15,16 have also demonstrated excessive length of stay attributed to nonclinical factors such as guardianship, though they did not quantify the excess stay or compare guardianship cases with a matched control. One study 17 demonstrated total charges of $150,000 per patient requiring guardianship, which are similar to our results. However, Chen et al also observed an average of 27.8 medically unnecessary days, which are 16 more days than those in our study sample.…”

“…The results of this study reflect the Massachusetts’ experience, with no public guardianship program or hierarchy statute. That being said, while this presumably causes the need for more guardianships in Massachusetts, the mechanisms for guardianship are broadly similar nationwide and are likely to result in excessive length of stay and cost similar to those in our population, as demonstrated in studies from other states 7,15‐17 …”

“…That being said, while this presumably causes the need for more guardianships in Massachusetts, the mechanisms for guardianship are broadly similar nationwide and are likely to result in excessive length of stay and cost similar to those in our population, as demonstrated in studies from other states. 7,[15][16][17] Implications At a time where medical systems are searching for opportunities to reduce the length of stay, prevent unnecessary hospitalization, and improve the quality of care, reevaluating the guardianship process is ripe with opportunity. In this single academic center, the process of guardianship was associated with 58% excess length of stay and 23% higher total hospital charges.…”

Getting Unstuck: Challenges and Opportunities in Caring for Patients Experiencing Prolonged Hospitalization While Stable for Discharge

“…These innovations may require unique partnerships and resource investment. Some health systems have designed solutions for guardianship administrative processing, 34 lack of caregiver, 35 intravenous antibiotic use in patients with substance abuse history, 36 homelessness, [37][38][39][40][41] and the need to provide durable medical equipment. 42 Expanding the ability of subacute health care settings to overcome internal barriers is an important area for future collaboration.…”

Barriers Beyond Clinical Control Affecting Timely Hospital Discharge for a Patient Requiring Guardianship

“…5 The entire guardianship process is complex and is well described in the literature. [2][3][4][5][6][7] Procedural delays in guardianship appointment contribute to the needless occupation of hospital beds and unnecessary costs. However, delays in hospital discharges due to nonclinical reasons beyond clinicians' control are seldom publicized.…”