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The Burden of Guardianship: A Matched Cohort Study
Author(s) -
Ricotta Daniel N.,
Parris James J.,
Parris Ritika S.,
Sontag David N.,
Bioethics M.,
Mukamal Kenneth J.
Publication year - 2018
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.2946
Subject(s) - legal guardian , medicine , confidence interval , cohort , retrospective cohort study , hospital medicine , confounding , cohort study , pediatrics , emergency medicine , law , political science
BACKGROUND In cases where patients are unable to provide informed consent and have no surrogate decision‐maker, a hospital must seek guardian appointment as a legally recognized surrogate decision‐maker. OBJECTIVE The aim of this study was to examine the magnitudes of length of stay (LOS) beyond medical clearance and healthcare costs among patients referred for guardianship. DESIGN, SETTING AND PATIENTS This was a retrospective cohort study of all 61 adult inpatients in a single tertiary care hospital requiring guardianship between October 1, 2014, and September 30, 2015, matched with up to three controls from the same discharging services and hospitalized for at least as long as the date of clearance for referred patients. MEASUREMENTS The following parameters were measured using generalized estimating equations: total LOS, LOS beyond medical clearance (excess LOS), medical complications, and total charges among referred patients, and the LOS and costs were compared with those of matched controls. RESULTS Mean LOS for patients requiring guardianship was 31 ± 2 days, and the total charges averaged $179,243 ± 22,950. We documented 12 hospital‐acquired complications in 10 (16%; 95% confidence interval [CI], 8%‐28%) unique patients. Accounting for potential confounders, the process of obtaining guardianship was associated with a 37% longer total LOS (95% CI [12 %‐67%]; P = .002), 58% higher excess LOS (95% CI [2%‐145%]; P = .04), and 23% higher total charges (95% CI [4%‐46%]; P = .02). CONCLUSION In this single‐center cohort study, the guardianship process was associated with prolonged hospital stay and higher total hospital charges even when compared with matched controls. Furthermore, one in six patients suffered from a hospital‐associated complication after medical clearance.