A discharge panel at Denver Health, focused on complex patients, may have influenced decline in length-of-stay.

Acute care hospitals struggle to manage complex patients who no longer require acute care services but who present medical and psychosocial challenges that make safe discharge to a lower level of care difficult. These challenges can be particularly acute at safety-net hospitals that cater predominantly to the poor and uninsured. For a person with a serious illness, such as a spinal cord injury, lack of insurance for long-term care services may add many weeks of medically unnecessary hospital days and result in higher costs. We describe safety-net system Denver Health's efforts to facilitate appropriate nonhospital care for these complex patients through the formation of a Complex Discharge Subcommittee. Successful solutions include accelerating legal guardianship approval to facilitate patient acceptance by skilled nursing facilities, as well as providing specialized equipment such as bariatric beds to nursing facilities to enable them to accommodate these patients. However, further policy interventions, such as updated reimbursement policies, are warranted.