The Burden of Guardianship: A Matched Cohort Study

J Hosp Med. 2018 Sep 1;13(9):595-601. doi: 10.12788/jhm.2946. Epub 2018 Feb 5.


Background: In cases where patients are unable to provide informed consent and have no surrogate decisionmaker, 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, 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 3 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).

Conclusions: 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.

MeSH terms

  • Female
  • Hospital Charges / statistics & numerical data*
  • Hospitalization / legislation & jurisprudence
  • Humans
  • Informed Consent / legislation & jurisprudence
  • Inpatients / legislation & jurisprudence*
  • Legal Guardians / legislation & jurisprudence*
  • Length of Stay / economics*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Discharge
  • Retrospective Studies