Getting Unstuck: Challenges and Opportunities in Caring for Patients Experiencing Prolonged Hospitalization While Stable for Discharge

Am J Med. 2020 Dec;133(12):1406-1410. doi: 10.1016/j.amjmed.2020.05.024. Epub 2020 Jun 30.


Many physicians care for patients who remain in the hospital for prolonged periods despite being "medically ready" or stable for discharge. However, this phenomenon is not well-defined, and optimal strategies to address the problem are not known. A prolonged hospitalization past the point of medical necessity can harm patients, frustrate care teams, and is costly for the health care system. In this perspective, we describe opportunities to improve value of care for these patients through the lens of the Quadruple Aim, a common framework used to guide health care transformation efforts. We then offer recommendations, including some employed by our hospitals, for clinicians, researchers, and health care systems to improve the care for patients who are "stuck" in the hospital.

Keywords: High value care; Hospital medicine; Quality improvement; Social determinants of health.

MeSH terms

  • Hospitalization*
  • Humans
  • Inpatients
  • Length of Stay*
  • Patient Discharge*
  • Quality of Health Care