Nonhome discharge, especially skilled nursing placement, was associated with longer stays above DRG-benchmarked expectations without lower short-term readmission in heart failure-related admissions.
Key Findings
Results
Discharge to skilled nursing facilities was associated with significantly more excess inpatient days compared to home discharge among heart failure admissions.
Discharge to skilled nursing was associated with 1.46 additional excess days versus home discharge (95% CI: 0.68–2.23; p < 0.001) in adjusted models.
Excess length of stay was defined as max(length of stay − CMS geometric mean length of stay, 0).
The final analytic sample included 1076 admissions from 743 unique patients.
Findings were directionally similar in sensitivity analyses.
Results
Discharge to other facility settings (non-skilled nursing, non-home) was also associated with significantly more excess inpatient days compared to home discharge.
Discharge to other facility settings was associated with 1.67 additional excess days versus home discharge (95% CI: 0.29–3.04; p = 0.017) in adjusted models.
Discharge destination was grouped as home, skilled nursing, other facility, or discontinued care.
The association was estimated using multivariable regression models.
Results
The mean excess length of stay across all heart failure-related admissions in the sample was 2.47 days.
Excess length of stay was defined as inpatient days beyond the CMS geometric mean length of stay for the relevant diagnosis-related group.
The study period covered admissions from August 2016 to October 2017 at a large academic urban teaching hospital.
The analytic sample comprised 1076 admissions from 743 unique patients.
Results
Excess length of stay was not associated with lower 30-day readmission rates.
24.3% of admissions were followed by a 30-day readmission.
A secondary generalised estimating equation model was used to assess 30-day readmission.
Nonhome discharge categories were also not associated with lower readmission odds.
This suggests that additional inpatient days beyond DRG expectations did not provide a protective effect against short-term readmission.
Methods
The study was a retrospective observational analysis of administrative data from a single academic urban teaching hospital.
Data covered admissions recorded between August 2016 and October 2017.
The primary outcome was excess length of stay; the primary explanatory variable was discharge destination.
Multivariable regression models estimated adjusted associations with excess length of stay.
The study did not directly measure the mechanisms underlying prolonged hospitalisation.
Discussion
The authors attributed the association between nonhome discharge and excess length of stay to greater discharge complexity and local postacute transition constraints.
The paper states findings 'may reflect greater discharge complexity and local postacute transition constraints.'
The study did not directly measure the mechanisms underlying prolonged hospitalisation.
The authors note this was a single-site observational sample, limiting generalisability.
What This Means
This research examined whether where a heart failure patient is sent after leaving the hospital — home, a skilled nursing facility, or another type of facility — is related to how many extra days they stay in the hospital beyond what is typically expected for their diagnosis. Using records from over 1,000 heart failure-related hospital stays at a single large teaching hospital, the researchers found that patients discharged to skilled nursing facilities or other non-home settings tended to stay about 1.5 to 1.7 extra days longer in the hospital compared to patients sent home, even after accounting for other factors.
Importantly, those extra hospital days did not appear to reduce the chances of being readmitted to the hospital within 30 days — about 1 in 4 admissions was followed by a readmission regardless. This suggests that spending more time in the hospital before being discharged to a post-acute care setting did not provide an added benefit in terms of preventing short-term returns to the hospital.
This research suggests that the process of arranging discharge to skilled nursing or other facility settings may be contributing to longer-than-expected hospital stays for heart failure patients, possibly due to the complexity of coordinating post-acute care placements. Since these extra days were not linked to fewer readmissions, there may be opportunities to streamline discharge planning for this patient population. However, because this was a single-site study using administrative records, the findings may not apply universally, and the specific reasons why stays were longer were not directly measured.
Singh D, Cameron K. (2026). Association Between Discharge Destination and Excess Length of Stay in Heart Failure-Related Admissions: A Retrospective Single-Centre Study.. Journal of evaluation in clinical practice. https://doi.org/10.1111/jep.70563