Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr;18(4):294-301.
doi: 10.1002/jhm.13061. Epub 2023 Feb 9.

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

Molly A Rosenthal  1 , Sumant R Ranji  2 , Hemal K Kanzaria  3   4   5   6 , Gabriel M Ortiz  2 , Jack Chase  7 , Anna H Chodos  2 , Oanh K Nguyen  2   5   6 , Eric G Rodriguez  4 , Anil N Makam  2   5   6
Affiliations
Free article

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

Molly A Rosenthal et al. J Hosp Med. 2023 Apr.
Free article

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.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Carey MR, Sheth H, Braithwaite RS. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med. 2005;20(2):108-115.
    1. Mustafa F, Gilligan P, Obu D, et al. “Delayed discharges and boarders”: a 2-year study of the relationship between patients experiencing delayed discharges from an acute hospital and boarding of admitted patients in a crowded ED. Emerg Med J. 2016;33(9):636-640.
    1. Meo N, Bann M, Sanchez M, Reddy A, Cornia PB. Getting unstuck: challenges and opportunities in caring for patients experiencing prolonged hospitalization while medically ready for discharge. Am J Med. 2020;133(12):1406-1410.
    1. Thomas SN, McGwin G, Rue LW. The financial impact of delayed discharge at a level I trauma center. J Trauma. 2005;58(1):121-125.
    1. Eriksson CO, Stoner RC, Eden KB, Newgard CD, Guise JM. The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review. J Gen Intern Med. 2017;32(6):686-696.