Characterizing patients hospitalized without an acute care indication: A retrospective cohort study

Abstract

Background: Hospitalizations by patients who do not meet acute inpatient criteria are common and overburden healthcare systems. Studies have characterized these alternate levels of care (ALC) but have not delineated prolonged (pALC) versus short ALC (sALC) stays.Objective: To descriptively compare pALC and sALC hospitalizations-groups we hypothesize have unique needs.Designs, Settings, and Participants: A retrospective study of hospitalizations from March-April 2018 at an academic safety-net hospital.Main Outcome and Measures: Levels of care for pALC (>3 days) and sALC (1-3 days) were determined using InterQual©, an industry standard utilization review tool for determining the clinical appropriateness of hospitalization.We examined sociodemographic and clinical characteristics.Results: Of 2365 hospitalizations, 215 (9.1%) were pALC, 277 (11.7%) were sALC, and 1873 (79.2%) had no ALC days. There were 17,683 hospital days included, and 28.3% (n = 5006) were considered ALC. Compared to patients with sALC, those with pALC were older and more likely to be publicly insured, experience homelessness, and have substance use or psychiatric comorbidities.Patients with pALC were more likely to be admitted for care meeting inpatient criteria (89.3% vs. 66.8%, p < .001), had significantly more ALC days (median 8 vs. 1 day, p < .001), and were less likely to be discharged to the community (p < .001).Conclusions: Patients with prolonged ALC stays were more likely to be admitted for acute care, had greater psychosocial complexity, significantly longer lengths of stay, and unique discharge needs. Given the complexity and needs for hospitalizations with pALC days, intensive interdisciplinary coordination and resource mobilization are necessary.

Medically ready for discharge: A multisite “point‐in‐time” assessment of hospitalized patients

“…The mechanism to explain this finding is not within the of this study, though it has been previously identified that patients experiencing homelessness, those with self-pay or Medicaid funding, and those of racial/ethnic minorities are more likely to experience prolonged LOS. 7,15,[22][23][24][25] This is an important area for further study.…”

Hospital-Based Medical-Legal Partnerships for Complex Care Patients: Intersectionality and Ethics Considerations

“…Patients with complex care needs often experience prolonged hospitalizations for non-acute reasons. 10 While numerous factors contribute to this dynamic, this frequently occurs because the patient lacks a safe or affordable placement option outside of the hospital. 11 Patients rarely prefer prolonged hospitalization, which is associated with serious health risks, including hospital-acquired complications, delirium, social isolation, depression, physical deconditioning, and loss of autonomy (e.g., hospital rules prohibiting patients from walking outside of the facility without permission).…”

Necessary hospitalizations, unnecessarily long stays: The problem of timely discharge

“…In this issue of the Journal , the characteristics of prolonged ALC (pALC) and short ALC (sALC) hospitalizations were compared based on a sample of adult patients 4 . ALC days accounted for approximately 20% of total inpatient days, while 10% of hospitalizations had pALC.…”