Concentration of excess hospital days among patients requiring postacute care referral.

Abstract

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. We evaluated whether excess hospital days are broadly distributed or concentrated among patients who require postacute care referral. 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. 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. 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.