Abstract
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Background: Prolonged hospital stays among older adults are associated with complex clinical, functional, psychosocial, family-related, and organizational challenges that extend across the continum of care. Understanding these interacting factors and translating evidence into actionable strategies are essential to support nursing and interprofessional practice, improve care transitions, and enhance patient experience. This study aimed to identify and characterize the factors influencing prolonged hospital stays among older adults and to translate these findings into practical representations that could support collective reflection and the identification of improvement strategies.
Methods: A qualitative study combining retrospective medical record analysis and a participatory World Café workshop was conducted in a regional health system in Quebec, Canada. In Phase 1, a proportional stratified sample of 100 paper-based medical records was selected from 2,976 adults aged 75 years and older with hospital stays exceeding 10 days. An inductive qualitative content analysis identified recurring clinical, functional, psychosocial, family-related, and organizational patterns across care pathways. These findings informed the development of four empirically grounded personas representing recurring prolonged hospitalization profiles. In Phase 2, the personas were used as structured reflection tools during a two-hour World Café involving 101 participants, including patient partners, nurses, physicians, allied health professionals, managers, and students. Participants identified needs, challenges, points of discontinuity, and potential drivers of improvement before, during, and after hospitalization.
Results: The analysis highlighted the multidimensional nature of prolonged hospital stays, characterized by interactions between clinical complexity and multimorbidity, functional decline and increasing dependency, psychosocial vulnerabilities, caregiver involvement, care transitions, and organizational barriers. During the participatory workshop, the personas provided a common reference point for stakeholders to examine these complex care pathways within their practice context. Cross-persona analysis identified shared priorities for improvement, including earlier and more proactive discharge planning, improved communication and coordination across care settings, greater integration of patients and family caregivers in care planning, and stronger continuity between hospital, primary care, and community services.
Conclusion: Combining qualitative analysis of real-world clinical data with empirically grounded personas and participatory reflection provided a structured approach to translating evidence on prolonged hospital stays into contextually relevant priorities for care improvement. The findings highlight opportunities to strengthen nursing and interprofessional practice, care coordination, and transitions across the continuum of care. This approach may support future evidence-informed quality improvement initiatives aimed at improving care pathways and the experience of older adults experiencing prolonged hospital stays.
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