Complex Discharges in the Third Largest Italian Hospital: Consequences, Economic Evaluation, and Assessment of a Low-cost Continuity of Care Reorganization

OBJECTIVES: Some patients cannot return home after hospitalization due to temporary or permanent disabilities, leading to so-called "complex discharge." This study aims to investigate the consequences and financial implications of complex discharge, and to assess a low-cost reorganization that removed a control point in the discharge process. MATERIALS AND METHODS: A retrospective observational study analyzed 21,448 hospital discharge records (HDRs) for 2019, and 18,584 HDRs for 2021, of the Molinette Hospital, the third largest Italian hospital. Factors influencing length of stay (LOS) were analyzed using linear regression models. The economic impact of complex discharge was simulated by assuming its absence, calculating the gain in production expected if hospital beds were used for noncomplex patients. To assess reorganization's impact, LOS was compared before and after its implementation using linear regression and interrupted time series (ITT) models. RESULTS: Factors associated with increased LOS included age, emergency admission, transfers to another hospital, and expected LOS based on diagnosis-related group. Complex discharge patients had a 50.2% longer LOS ( P < 0.001, adjusted R2 of 36.47%). Simulating absence of these patients provided an expected gain in production equal to 4,522,879.93€. The reorganization reduced LOS by 6.1 days for the 72 affected patients. The ITT analysis showed that the intervention flattened the preexisting LOS upward trend ( P < 0.001, adjusted R2 of 33.21%). CONCLUSIONS: Complex discharge significantly increases LOS, with an important economic impact. The reorganization was a low-cost intervention that significantly modified the discharge dynamics, demonstrating its potential for improving patient outcomes and reducing health care costs.