title: Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge.
abstract: 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.
  
  
  CONCLUSIONS
  Extra-clinical factors are important determinants of prolonged hospitalization in acute inpatient settings.
authors.affiliation: Mental Health Unit, Center of Epidemiology, Health Surveillance and Promotion, Italian National Institute of Health, Roma, Italy. antonella.gigantesco@iss.it
authors.forename: Antonella
authors.initials: A
authors.lastname: Gigantesco
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Santone
authors.forename: Rossella
authors.initials: R
authors.lastname: Miglio
authors.forename: Angelo
authors.initials: A
authors.lastname: Picardi
mesh_terms: D000328:Adult; D005260:Female; D058016:Health Facility Administration; D006801:Humans; D007297:Inpatients; D007558:Italy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012307:Risk Factors
references.citation: Br J Psychiatry. 2002 Sep;181:220-5
references.pmid: 12204926
references.citation: Psychiatr Serv. 2001 Aug;52(8):1051-6
references.pmid: 11474050
references.citation: Acta Psychiatr Scand. 2001 Mar;103(3):203-11
references.pmid: 11240577
references.citation: Health Policy. 2005 Oct;74(2):115-21
references.pmid: 16153472
references.citation: Psychiatr Serv. 2001 Jan;52(1):75-80
references.pmid: 11141532
references.citation: Rev Saude Publica. 2006 Aug;40(4):699-705
references.pmid: 17063248
references.citation: Psychiatr Serv. 1998 Aug;49(8):1049-53
references.pmid: 9712211
references.citation: Gen Hosp Psychiatry. 1997 Mar;19(2):112-8
references.pmid: 9097065
references.citation: Acta Psychiatr Scand. 2000 Apr;101(4):323-9
references.pmid: 10782554
references.citation: Int J Geriatr Psychiatry. 1998 Jan;13(1):1-7
references.pmid: 9489573
references.citation: Psychiatr Serv. 2003 Sep;54(9):1271-6
references.pmid: 12954945
references.citation: BMC Health Serv Res. 2004 Feb 17;4(1):4
references.pmid: 15102334
references.citation: Schizophr Bull. 2002;28(2):273-81
references.pmid: 12693433
references.citation: Br J Psychiatry. 2007 Aug;191:170-7
references.pmid: 17666503
references.citation: Acta Psychiatr Scand. 1999 Sep;100(3):220-8
references.pmid: 10493089
references.citation: Psychiatr Serv. 2001 Oct;52(10):1367-73
references.pmid: 11585954
references.citation: Acta Psychiatr Scand. 1999 May;99(5):341-7
references.pmid: 10353449
references.citation: Psychiatr Serv. 2004 May;55(5):560-5
references.pmid: 15128965
references.citation: Aust N Z J Psychiatry. 2007 Jun;41(6):509-18
references.pmid: 17508321
references.citation: Br J Psychiatry. 1994 Aug;165(2):170-8
references.pmid: 7953030