Prolonged Length of Hospital Stay and Delayed Discharges Among Patients Referred to Child Psychiatry Liaison Services: A Five-Year Retrospective Analysis.

Abstract

Objective: To identify factors contributing to prolonged length of hospital stay (LOS) and delayed discharges (DD) among children referred to Paediatric Consultation-Liaison Psychiatry Services (PLPS) in a tertiary paediatric hospital in Ireland.

Study design: A five-year retrospective chart review from April 2019 to May 2024 was conducted, examining demographic, clinical, and systemic data for patients with prolonged admissions (LOS > 30 days) and delayed discharges. Clinician perspectives were gathered through semi-structured interviews; thematic analysis was applied to qualitative data to identify key themes related to discharge barriers.

Results: A total of 107 patients met criteria for prolonged LOS. Delays were most commonly attributed to systemic barriers, including limited access to inpatient psychiatric units and inadequate community-based support services, as well as patient-related factors such as complex psychiatric comorbidities (notably eating disorders and neurodevelopmental conditions). Clinician interviews highlighted additional themes, including resource constraints and challenges in discharge planning. Prolonged hospitalization for psychiatric reasons in medical wards was associated with significant strain on resources, delayed treatment, and increased safety concerns.

Conclusions: Findings highlight the need for improved interagency collaboration, expanded access to psychiatric inpatient care, and the development of streamlined, resource-appropriate discharge pathways. Addressing these challenges is essential to reduce inappropriate hospital stays and improve outcomes for pediatric patients with mental health needs.