- Design
- Retrospective cohort, single academic centre
- Population
- 20,986 adult inpatient encounters (14,879 patients), 2023
- Primary outcome
- Length of stay and excess days by post-acute referral status
- Effect
- Referral encounters held 85.5% of excess days; median +2.92 days LOS, +2.11 excess days
A retrospective cohort at a 714-bed US academic centre examined 20,986 adult admissions in 2023. Nearly half (48.4%) involved a referral for post-acute care — rehabilitation, nursing facility or home services — used as a marker of discharge complexity.
Those referral admissions accounted for 85.5% of all excess hospital days. After adjusting for age, sex, service and case severity, they had a median stay 2.92 days longer and 2.11 more excess days.
The authors are careful: the referral itself did not cause the delay; it marks the patients whose discharge is complex. For ward teams, it means effort to shorten stays belongs with this group, and it starts with identifying them early.
- Excess bed days concentrate in patients who need post-acute care — target discharge planning there.
- Start post-acute referrals as soon as the need is likely, not on the day of medical fitness.
- Flag patients likely to need placement at the first board round.
- Medical optimisation alone will not shorten these stays; the bottleneck is the referral pathway.
Why it matters
Length-of-stay drives often target every patient, but most excess days sat in one identifiable group.
Don't overread it
Single-centre and US-specific — post-acute care systems elsewhere may delay patients for different reasons.
The statistics, in plain English
Median differences were estimated with quantile regression, which compares the middle patient in each group and is less distorted by a few very long stays than an average would be.
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