Causes of Prolonged Hospitalization among General Internal Medicine Patients of a Tertiary Care Center
Darat Ruangkriengsin MD*, Pochamana Phisalprapa MD*
Affiliation : * Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Unnecessary days of prolonged hospitalization may lead to the increase in hospital-related complications and
costs, especially in tertiary care center. Currently, there have not been many studies about the causes of prolonged hospitalization.
Some identified causes could, however, be prevented and improved.
Objective : To identify the prevalence, causes, predictive factors, prognosis, and economic burden of prolonged hospitalization
in patients who had been in general internal medicine wards of the tertiary care center for 7 days or more.
Material and Method: Retrospective chart review study was conducted among all patients who were admitted for 7 days or
more in general internal medicine wards of Siriraj Hospital, the largest tertiary care center in Thailand. The period of this
study was from 1 August 2012 to 30 September 2012. Demographic data, principle diagnosis, comorbid diseases, complications,
discharge status, total costs of admission and percentage of reimbursement were collected. The causes of prolonged
hospitalization at day 7, 14, 30, and 90 were assessed.
Results : Five hundred and sixty-two charts were reviewed. The average length of stay was 25.9 days. The two most common
causes of prolonged admission at day 7 were treatment of main diagnosed disease with stable condition (27.6%) and waiting
for completion of intravenous antibiotics administration with stable condition (19.5%). The causes of prolonged hospitalization
at day 14 were unstable condition from complications (22.6%) and those waiting for completion of intravenous antibiotics
administration with stable condition (15.8%). The causes of prolonged admission at day 30 were unstable conditions from
complications (25.6%), difficulty weaning or ventilator dependence (17.6%), and caregiver problems (15.2%). The causes
of prolonged hospitalization at day 90 were unstable condition from complications (30.0%), caregiver problems (30.0%),
and palliative care (25.0%). Poor outcomes were shown in the patients admitted more than 90 days. Percentage of death,
being bedridden, and re-admission were 55, 40, and 22, respectively. The goal of treatment was only palliative care in 80
percent of this patient group. Respiratory failure among the hospitalized was the strongest predictive factors of death (Odds
ratio = 7.5, p<0.001). The average costs of admission per patient was 163,870 THB and the percentage of reimbursement
was only 72%. For total costs of admission in these two months, Siriraj Hospital lost a large amount of money (about 26
million THB) for patients admitted for 7 days or more and almost 50% of this was spent on the patients admitted for 90 days
or more. The average cost of admission per patient in the latter group was 1,073,004 THB.
Conclusion : Prolonged hospitalization had adverse outcomes for the patients and the hospital, such as high complications,
poor outcomes, high costs of treatment and low reimbursement ratio that created an enormous economic burden for the
hospital. Therefore possible preventable causes of prolonged admission must be identified, prevented and managed by
improving quality of multidisciplinary health care system and ancillary services.
Keywords : Prolonged hospitalization, Length of stay, General internal medicine, Tertiary care center
