Prolonged Hospitalization and Adverse Events in Veterans Awaiting Guardianship: A Retrospective Cohort Analysis.

BACKGROUND: Hospitalized adults who are deemed to lack both capacity for medical decision-making and an appropriate surrogate often have prolonged hospital stays while awaiting a guardian. OBJECTIVE: To characterize the inpatient management, adverse hospital events, and outcomes of patients hospitalized while pending guardianship in the Veterans Affairs (VA) system. DESIGN: Retrospective cohort analysis completed via chart review and standardized data abstraction. PARTICIPANTS: Veterans admitted to an inpatient medicine service with a guardianship application pending at any point during hospitalization and discharged between Jan 2020 and Dec 2021 at 14 VA hospitals across the USA. MAIN MEASURES: We analyzed patient demographics, length of stay, capacity assessment, inpatient medication management, adverse events, guardianship attainment, disposition, readmission, and mortality rates of medicine patients hospitalized while pending guardianship. KEY RESULTS: One hundred seventy Veterans hospitalized while awaiting guardianship were included. The median length of stay was 38.5 days and 60% (n = 102) of patients were admitted for placement or a mix of placement plus medical/surgical reasons. Forty-five percent (n = 77) of patients experienced at least one of the following: involuntary hold, behavioral code, elopement attempt, or use of restraints; and 28% (n = 47) of patients experienced at least one hospital acquired infection or fall. Three percent (n = 5) of patients died, one related to an adverse hospital event. At the endpoint of the study, 72% (122/170) of patients obtained guardianship. CONCLUSIONS: At VA hospitals, medicine patients awaiting guardianship have prolonged length of stay and a significant number are admitted for placement reasons. Patients experienced high rates of hospital-acquired adverse events as well as anti-wandering and behavioral interventions such as restraints or medical holds. Most patients ultimately achieved guardianship. These findings have implications for policy makers and health care systems to address guardianship processes and mitigate effects of prolonged and sometimes unnecessary hospitalizations in this vulnerable population.

Duke Scholars

Author Joel Boggan Medicine, Hospital Medicine