Feasibility of medical-legal partnership to improve inpatient outcomes and reduce hospital length of stay

INTRODUCTION: Length of stay (LOS) is an important quality metric often affected by social determinants of health, including health-harming legal needs (HHLNs). We sought to determine the feasibility of medical-legal partnerships (MLPs) in the inpatient setting to improve LOS. 

METHODS: Adult patients admitted to a safety-net public hospital beyond medically predicted LOS (n=110) were assessed for HHLNs via chart review and standardized surveys then referred for legal intervention if indicated. Staff were surveyed regarding HHLNs and MLPs. Retrospective cost-analysis was performed one year later. 

RESULTS: Average excess LOS days were 41±51, and HHLNs were identified among 69% of patients. The need for guardianship was specifically associated with increased excess LOS (p=.03). Staff reported interest in MLPs, and referrals increased after initial exposure. Cost-analysis at one year showed savings in excess of $200,000. 

CONCLUSIONS: Medical-legal partnerships have potential to reduce excess LOS, improving inpatient clinical outcomes and health care cost-effectiveness.