Golisano Institute Adopts Multi-Partner Collaboration to Decrease Prolonged Hospital Stays for Patients with IDD
It’s an issue facing individuals with intellectual and developmental disabilities across the region, state, and nation: prolonged hospital stays – sometimes for months, or even years – are emotionally-stressful and can often lead to new health challenges due to inactivity and restricted environments.
“It’s a significant concern – particularly for patients with profound autism. Patients are not in the hospital because they need to be, they are often there because they have nowhere to go,” explained Dr. Deborah A. Napolitano, associate professor in the Department of Behavioral Science at Daemen University. “Patients come to the hospital or emergency unit with an acute medical condition but end up staying because of behavioral issues and they have nowhere to be discharged.”
Napolitano points to a study published in 2024 by the Healthcare Association of New York State, where 52 hospitals reported that more than 500 patients remained in their care for a month or more after they were ready for discharge. Hospitals bear the financial burden, health care teams struggle with the complications of meeting patients’ needs, and patients themselves experience a severe decrease in the quality of life.
Enter the Golisano Institute for Developmental and Disability Nursing at St. John Fisher University, whose mission is to transform the quality of care and support for individuals with IDD by training nursing professionals to care for this unique population. Recognizing prolonged hospital stays are a major issue, the Institute team began working with partners in the community to develop a systems-based solution.
The result: a three-pronged approach that includes deepening nurse knowledge around patients with IDD, developing leadership acumen among nurses to implement changes across their health systems, and connecting nurses to resources and experts within the community.
The Approach in Practice
What does the approach look like in practice? Dr. Holly Brown, executive director of the Institute, points to a success story with a nurse leader in a medical-surgical unit at Erie County Medical Center, who completed the Institute’s training modules and fellowship program. Armed with new knowledge, the nurse was well-prepared when a young patient with IDD was admitted to her unit. The patient faced significant challenges that were exacerbated by destructive behaviors that required constant supervision for safety, and a language barrier that complicated communication efforts. Brown said the nurse put processes in place to ensure consistency and structure, and with the support of her health system, she also created a sensory room to give patients (and even nurses themselves) a place for calm and comfort.
The Institute team connected the nurse with Napolitano, a behavior analyst, and two other faculty/behavior analysts from the Golisano School of Health and Human Sciences at Daemen University. The behavior analysts, through a generous grant from the Tower Foundation, worked alongside the ECMC team to help address behavioral concerns that were preventing the patient from finding an appropriate discharge placement. Experts from Daemen monitored patient agitation levels every 30 minutes to gather data and identify patterns. Their analysis revealed insights that the nursing team used to focus on providing extra care during the times when the patient was most likely to display behaviors of concern. Almost immediately, this adjustment reduced the need for restrictive interventions. Once behavioral escalations were addressed and even prevented, the interprofessional team could begin to work with the patient on behavioral skills and progress in ways that were not possible before.
Finding Success
The efforts were successful. The patient was discharged after just a month and a half—far sooner than the year or more often experienced in the past in such cases. The patient also was discharged with new skills to support living outside the hospital setting.
“This success underscores the ripple effect of the Golisano Institute. The nurse’s compassion, paired with her training from the Golisano Fellowship and collaboration from partners, helped drive a systemic change,” said Brown. “We believe that if implemented broadly at hospitals across the state, this approach can reduce costs, lower staff burnout, and—most importantly—reduce unnecessary, prolonged hospital stays and ensure patients with IDD receive the high-quality care they deserve.”