title: Nonmedical factors associated with prolonged hospital length of stay in an urban homebound population.
abstract: BACKGROUND
  Prolonged length of stay (LOS) is a major concern for hospitalized populations at risk for adverse events. Homebound patients are at particular risk for long stays and may have unique discharge needs because of their commitment to be cared for at home despite poor functional status.
  
  
  OBJECTIVE
  The goal of this study was to describe factors contributing to long hospitalizations in the homebound population.
  
  
  METHODS
  This retrospective observational pilot study included all 2007 discharges that occurred for patients at The Mount Sinai Hospital enrolled in the Mount Sinai Visiting Doctors Program.
  
  
  METHODS
  Long-stay patients were defined as those having an LOS 2 standard deviations above the mean. Hospitalization days were defined as "nonmedical" when patients medically ready for discharge remained in the hospital. Patients discharged immediately after determination of medical readiness were characterized as "medical stay" cases. The University HealthSystems Consortium Database was used to calculate expected LOS and the LOS ratio. Chart reviews were performed to describe long-stay cases as nonmedical or medical.
  
  
  RESULTS
  The average LOS for 479 discharges was 7.84 days, with a mean LOS Ratio of 1.23. Seventeen cases were determined to be long stays. Eight of these cases (47%) were defined as nonmedical stays. These accounted for 136 days of hospitalization and 32% of total long-stay days. The most common reason for a nonmedical stay was nursing facility placement delay.
  
  
  CONCLUSIONS
  Nonmedical factors accounted for nearly one-third of all long-stay days in the hospitalized homebound population. Increased interdisciplinary collaboration may help address homebound patient LOS.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA. dinah.foer@yale.edu
authors.forename: Dinah
authors.initials: D
authors.lastname: Foer
authors.forename: Katherine
authors.initials: K
authors.lastname: Ornstein
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Soriano
authors.forename: Navneet
authors.initials: N
authors.lastname: Kathuria
authors.forename: Andrew
authors.initials: A
authors.lastname: Dunn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000639:trends; D018577:Homebound Persons / Q000534:rehabilitation; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D014505:Urban Population; D014850:Waiting Lists