Abstract
Background A guardianship is a legal process that takes place when a patient cannot make informed healthcare decisions and there is no Health Care Proxy. A court appoints a person to serve as guardian. The burden was on a patients family to navigate the court system when a guardianship was necessary. This was difficult because Massachusetts has no public guardian program. BMC began this project to: improve the overall length of stay for patients who need a guardian; to avoid delays in care while awaiting appointment of a guardian; and to reduce costs related to discharge delays.
Objectives To significantly reduce the number of days a patient who lacks capacity remains inpatient because of judicial guardianship issues.
Methods We formed a multi-disciplinary group consisting of hospital stakeholders. This group identified, planned and executed interventions to streamline the guardianship processes. The group followed IHIs Model for Improvement using PDSA cycles.
Results We implemented three simultaneous interventions: engaging outside counsel to handle guardianship cases; establishing a weekly guardianship committee to review the status of inpatients who might need a guardian; pursuing the completion of Health Care Proxy forms. These interventions immediately created a more efficient guardianship process.
Conclusions Using outside counsel and establishing a guardianship oversight group to regularly review the status of patients admitted longer than the hospitals average length of stay will: reduce unnecessary hospital stays caused by delays in the process; reduce the costs related to prolonged stays; and increase the availability of hospital beds for patients in need of acute health care services.
