Reasons for prolonged hospital stay: A study of need for hospital care

Abstract

1. 1. In four general hospitals in Boston, Massachusetts, a study of patients staying 30 days or longer was made to determine the reasons for their prolonged hospitalization and to define the factors affecting hospital utilization. It included an analysis of a sample of patients discharged in 1953 and a detailed review, by a team of professional persons, of a sample of 369 “long-stay” patients in the four hospitals in the year 1954. 2. 2. Each of the long-stay patients in the sample was evaluated as to specific requirements for service on the basis of specially developed criteria including a list of facilities performing different functions and a list of patient characteristics indicating need for service in one of the various types of facility. 3. 3. As the discharge study showed, only about 6 per cent of all patients remained in the hospital 30 days or longer, but this group accounted for almost one-third of the total patient days rendered. 4. 4. The case study revealed that about 56 per cent of the long-stay patients required continuing active treatment in the hospital, while 42 per cent did not require it, although many of them needed other types of care. 5. 5. The main reasons for keeping patients in the hospital despite absence of need for continued active treatment were unsuitability of the patient's home, reluctance of the family to accept the patient, and lack of other facilities and services—such as institutions for long-term care of the sick, homelike institutions for those who need shelter and aid, and organized programs of home care. 6. 6. The long-stay group contained a relatively large proportion of elderly people and of patients with tumors, cardiovascular diseases, and injuries. 7. 7. The methodology developed for this study lends itself to wider application. It is believed that the methods developed may be useful in making estimates of future need for general hospital beds, and for the various types of physical facilities and services required for the humane, efficient, and economical care of patients with prolonged illness. 8. 8. The findings indicate the importance of availability and effective co-ordination of various types of facilities for medical care, and other services for the sick and infirm in the community.