Characterization of hospitalizations of patients who stay longer than expected at the Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP) and its economic implications Thesis by Paulo Cesar Zapparoli de Souza Lima. Advisor: Nivaldo Carneiro Junior and Paulo Carrara de Castro

Introduction: An adequate resource management, of all types, that contributes to better healthcare results, conferring a better strategy for the organization of the healthcare system and practice, should be a critical point for managers and administrators. In this direction, there is a global interest in improving the allocation of resources so that healthcare systems achieve their main objectives. Hospitalizations with length of stay beyond the expected by established protocols or by historical averages of national health systems, change the dynamics of the entire hospitalization process. The impacts of blocked beds are of care delivery and economic nature. Objective: to study the characteristics of the occurrences of length of stay beyond the expected inpatients admitted to Hospital Central da ISCMSP and its economic implications. Method: quantitative, descriptive observational study of secondary data using data extracted from hospitalizations with discharges occurring in the year 2019, at the Central Hospital of ISCMSP. Results: the permanence of hospitalizations beyond the expected time had an important influence on the variables revenue, cost, economic result and care outcome. The profile above the limit of the SIGTAP table presented the longest stays, the highest revenues, the highest costs and the worst economic results. Patients who entered through the emergency room were the majority of those hospitalized in the profile above the limit of the SIGTAP table. The emergency gateway was an important factor for a higher proportion of deaths. There was a higher proportion of ICU admissions in the profile above the threshold, when compared to the profile below/equal (82.1% versus 17.8%). The overall institutional death rate was 6.1% and in the ICU it was 23.0%. Of the total number of deaths (1,250), 92.8% originated through the emergency room door. The institutional death rate for patients admitted to the ICU and with a stay above the expected limit was 4.9 times higher than the rate of patients in the profile below. Conclusion: the study suggests an association between permanence beyond the expected time and results, both in terms of care and economics. The future investigation of the determining causes of stays beyond the expected time is necessary.

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