Patient Factors Associated with Extended Length of Stay in the Psychiatric Inpatient Units of a Large Urban County Hospital

Abstract

This case-control study identified patient-specific factors associated with the longest psychiatric inpatient lengths of stay (LOS) at a large urban county hospital. Subjects with LOS ≥ 60 days comprised the extended LOS (ELOS) case cohort. An equally-sized control cohort consisted of a random sample of inpatients with LOS ≤ 30 days. T-tests and chi-square tests were conducted to determine differences between groups. Factors associated with ELOS included older age, cognitive impairment, higher number of medical conditions requiring medication, and violence during hospital stay. Initiatives focused on community placement of patients with these characteristics may reduce prolonged LOS at safety-net hospitals.

<p>Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward</p>

“…18 In particular, among the longest hospitalizations, the presence of aggressiveness, either moderate or severe, and the need for complex therapeutic treatment during the hospitalizations were the statistically significant conditioning factors of hospitalization prolongation, in line with the results of other authors who highlighted that violence during the hospitalization as well as high number of medical conditions requiring medication could prolong the period of stays. 35 Aggressiveness, which was particularly frequent among the patients with the longest hospitalizations in our and other studies, 14,18 could represent a severe and acute symptom of many psychiatric disorders, often responsible for hospital admission, frequent readmissions 3 and, according to other research, 36 for the frequent aggressions towards staff, in particular nurses, 37 in a psychiatric setting. The observation of serious and potentially dangerous aggressive behavior among patients with long-term hospitalizations corresponded with the data of the higher frequency of compulsory treatment in this group, which suggests the lack of illness awareness and behavior control among these patients.…”

Study of Factors Influencing the Length of Hospital Stay of Patients with Anxiety Disorders

“…The results showed that diagnosis and age consist of 5.1% of the variance of the length of stay in the hospital and 3.11% of the variance was determined by clinical and demographic characteristics. This finding doesn't support those of Cheng et al, who identified that older age is associated with the longest psychiatric inpatient length of stay (17). In the current study between factors such as gender, type of residence, insurance status, and duration of disorder to the duration of hospitalization, no relation was found.…”

Características personales, clínicas y sociales en pacientes con estancia hospitalaria prolongada en los pabellones de pacientes agudos del Hospital Víctor Larco Herrera

“…Nuestro estudio en función a la evolución favorable de los pacientes, deja una vez más abierta la posibilidad de que el factor más importante asociado a la estancia hospitalaria, no es el factor clínico, sino que, a pesar del buen manejo de los pacientes y su evolución favorable, se atribuyen factores sociales, personales y judiciales, principalmente, que escapan al control del equipo de salud del personal y por ende al cumplimiento de los estándares establecidos para una adecuada estancia hospitalaria, concordando también con los hallazgos de Cheng (14) , pero contrapuesto a Anderson (15) y Øiesvold (16) , que dan mayor importancia a la complejidad clínica (por ejemplo, estados psicóticos y admisiones planificadas) y no otros factores. Otros estudios de predicción de factores clínicos y el tiempo de hospitalización, no llegan a ser compatibles con los hallazgos particulares de nuestro trabajo (17,18,19) .…”