Barry Hahn, Kurien Mathews, Ahmad Nama, Anna Van Tuyl, Amin Mohamadi, Josh Greenstein
Excess hospital days were concentrated in a small group of encounters, most of which involved postacute care referral. Referral status should be interpreted as a marker of discharge complexity, not as evidence that referral caused prolonged hospitalization.
BACKGROUND: Hospital length of stay (LOS) contributes to inpatient capacity constraints and emergency department crowding. Nonclinical factors, particularly discharge complexity related to postacute care needs, may drive prolonged hospitalization.
OBJECTIVES: We evaluated whether excess hospital days are broadly distributed or concentrated among patients who require postacute care referral.
METHODS: We conducted a retrospective cohort study of inpatient encounters among adults aged 21 years and older at a 714-bed academic medical center in 2023. Postacute care referral was used as an encounter-level marker of discharge complexity. Adjusted median differences in LOS and excess days were estimated using quantile regression with bootstrap confidence intervals clustered by patient.
RESULTS: The cohort included 20,986 encounters among 14,879 patients, and 48.4% of encounters involved postacute care referral. Referral encounters accounted for 85.5% of all positive excess days. After adjustment for age, sex, hospital service group, and MS-DRG severity weight, referral encounters had a 2.92-day longer median LOS and 2.11 more median excess days.
CONCLUSIONS: Excess hospital days were concentrated in a small group of encounters, most of which involved postacute care referral. Referral status should be interpreted as a marker of discharge complexity, not as evidence that referral caused prolonged hospitalization.