Research article
Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge
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* Corresponding author: Giovanni de Girolamo gdegirolamo@fatebenefratelli.it
1 Mental Health Unit, Center of Epidemiology, Health Surveillance and Promotion, Italian National Institute of Health, Roma, Italy
2 Psychiatric Unit, United Hospitals of Ancona & Polytechnic University of Marche, Ancona, Italy
3 Department of Statistics, University of Bologna, Bologna, Italy
4 Fatebenefratelli Hospitalization and Care Scientific Institute, Brescia, Italy
BMC Public Health 2009, 9:306 doi:10.1186/1471-2458-9-306
Published: 22 August 2009Abstract
Background
The aim of the present study was to assess the characteristics of long-stay inpatients in public and private Italian acute inpatient facilities, to identify risk factors and correlates of the long duration of hospital stay in these patients, and to identify possible barriers to alternative placements.
Methods
All patients in 130 Italian public and private psychiatric inpatient units who had been hospitalized for more than 3 months during a specific index period were assessed with standardized assessment instruments and compared to patients discharged during the same index period, but staying in hospital for less than 3 months (short-stay inpatients). Assessed domains included demographic, clinical, and treatment characteristics, as well as process of care. Logistic regression analysis was used to identify specific variables predicting inpatient long-stay status. Reasons for delaying patient discharge, as reported by treatment teams, were also analyzed.
Results
No overall differences between long-stay and short-stay patients emerged in terms of symptom severity or diagnostic status. Admission to a private inpatient facility and display of violent behavior during hospital stay were the most powerful predictors of long-stay. Lack of housing and a shortage of community support were the reasons most commonly cited by treatment teams as barriers to discharge.
Conclusion
Extra-clinical factors are important determinants of prolonged hospitalization in acute inpatient settings.