Prolonged Hospitalizations in an Internal Medicine Ward

Abstract

Introduction: Internal Medicine wards host complex patients,
elderly, frail, dependent, with multiple co-morbidities and frequently social issues, which may cause long hospitalizations.
We intend to characterize the population with prolonged hospitalizations, analyzing whether they were adequate to the
clinical situation or related to socioeconomic issues.
Methods: Retrospective study conducted during the year of
2014 in an Internal Medicine ward that included patients with
hospitalization days higher than 20. Prolonged hospitalizations were classified as appropriate if due to complex clinical
presentation, complications or iatrogenies, and inappropriate if related to lack of post-discharge conditions.
Results: One hundred and seventy seven prolonged hospitalizations (10.4% of all admissions); 53 men, mean age 76
years. Average 33.8 days of hospitalization; 39% had previous clinical discharge – 1653 days of postponed discharge.
At admission, 36% were partial and 17% totally dependent.
Comorbidities: hypertension (75%), cerebrovascular disease
(52%), diabetes (35%), dementia (28%). Prevalent main diagnoses: stroke (21%), pneumonia (14%), neoplasia (11%);
14% required intensive/intermediate care units. In 64% the
preponderant prolongation factor was clinically appropriate
- 77% due to complexity and 15% to nosocomial infections.
Referred to the National Network of Integrated Continuous
Care were 23%. Mortality 13.0%. Thirty-six months post-discharge, 59% had been hospitalized, 23% had prolonged
hospitalizations and 57 patients died - mortality rate of 37%
in 3 years.
Conclusion: Patients with prolonged hospitalizations are heterogeneous with respect to diagnosis and specific needs.
Despite 36% of prolonged hospitalizations being caused by
post-discharge conditions, most were appropriate to the severity, clinical complexity or complications during the hospitalization.