Predicting Length of Stay in an Acute Care Hospital

Abstract

In an acute care hospital, a major performance indicator is patient length of stay. This study, in a large university teaching acute care hospital in Canada, examined the effect of psychosocial problems on length of stay, controlling for patient demographics and medical condition. Average days stay for Diagnostic Related Groups (DRGs) was used as a proxy variable for severity of medical condition, and the Person-in-Environment (PIE) classification system was used to measure psychosocial problems. Data were collected on a sample of 160 patients; 78 in psychiatry and 82 in medical/surgical wards. In a regression analysis, the severity of the patient's psychosocial problem was a more significant predictor of length of stay than the DRG variable. The identification of psychosocial problems and their severity add an important and complementary dimension to research into the effectiveness of social workers in reducing length of stay. Workers found clients had significantly more problems related to their social role functioning than problems in the environment.

Disability Impacts Length of Stay in General Internal Medicine Patients

“…This follows previous literature where LOS was longer in patients with psychosocial problems, caregiver unavailability or who faced administrative issues delaying discharge. 7,19,28,29 We believe that this was similar in our institution, where patients with disabilities are more reliant on caregivers.…”

“…17,18 Longer LOS has been associated with increased severity of social problems. 7,19 Social issues were also documented if these interfered with the team's plan for discharge. The social issues were categorized into the following because of their prevalence on our clinical practice: caregiver unavailability, noncompliance, psychological issues/unrealistic expectations, financial issues and administrative issues.…”

Determinants of Geropsychiatric Inpatient Length of Stay

“…LOS was directly correlated with score on the BPRS positive symptoms subscale; very low scores (1-10) were associated with decreases in LOS while very high scores (31)(32)(33)(34)(35)(36)(37)(38)(39)(40) were associated with a greater than 82% increase. This suggests that the BPRS positive symptom subscale might be used to identify patients with potentially longer LOS.…”

“…Inconsistent correlations with length of stay have been noted for key demographic characteristics; (1,(20)(21)(22)(23) age, gender and marital status are found to be both good (9,(24)(25)(26)(27)(28)(29)(30)(31)(32) and poor (1,14,(20)(21)(22)27,33,34) predictors of LOS. Interestingly, psychiatric diagnosis without some measure of severity and the diagnostic related groups (DRGs) used for Medicare reimbursement are also unpersuasive as predictors of LOS with as many studies finding them related to LOS (2,(5)(6)(7)17,21,22,24) as not (3,(9)(10)(11)(12)18,(35)(36)(37)(38)(39).…”

“…Prior research has found increased LOS among geriatric psychiatric patients to be associated with falling while hospitalized (16)(17)(18)(19)(20)(21)40), inability to return to prior living arrangement (1,20,33), ECT (16,17), and greater severity of psychiatric illness (23,36,37,41,42). On the other hand, cognitive impairment (21,22) has not been found to influence LOS.…”