Discharge Delays for Patients Requiring In-Hospital Guardianship: A Cohort Analysis

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To assess nonclinical factors delaying hospital discharge of guardianship patients.


Utilization review data over 3 years.


Retrospective cohort study.


Mann–Whitney test was used to compare patients' medically unnecessary days (MUD) of hospitalization with additional subcategories of delays—defined as beyond clinicians' control.


Overall median number of MUD was 19.5; 14 of 48 patients were additionally delayed while awaiting long-term care Medicaid approval (N = 7, 50%), pending insurance (N = 3, 21%), social or transportation difficulties (N = 3, 21%), or preadmission review (N = 1, 7%). The median number of MUD for the 14 delayed patients was 63, a difference of 53 days compared with the routine guardianship cohort (P < .0001) and $5.5M in net revenue opportunity.


Nonclinical discharge delays for guardianship patients are costly and potentially unavoidable. Further exploration into policy change is therefore recommended.

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