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Benevides Santos Paiva M, de Gouvêa Viana L, Melo de Andrade MV. Reduction of hospital length of stay through the implementation of SAFER patient flow bundle and Red2Green days tool: a pre-post study. BMJ Open Qual 2024; 13:e002399. [PMID: 38191217 PMCID: PMC10806560 DOI: 10.1136/bmjoq-2023-002399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND In 2018, the National Health System released the 'Guide to reducing long hospital stays' to stimulate improvement and decrease length of stay (LOS) in England hospitals. The SAFER patient flow bundle and Red2Green tool were described as strategies to be implemented in inpatient wards to reduce discharge delays. OBJECTIVE To verify if implementing the SAFER patient flow bundle and Red2Green days tool is associated with LOS reduction in the internal medicine unit (IMU) wards of a university hospital in Brazil. METHODS In this pre post study, we compared the LOS of patients discharged from the IMU wards in 2019, during the implementation of the SAFER bundle and Red2Green tool, to the LOS of patients discharged in the same period in 2018. The Diagnosis-Related Group Brazil algorithm compared groups according to complexity and resource requirements. In-hospital mortality, readmission rates, the number of hospital acquired conditions and the number and causes of inappropriate hospital days were also evaluated. RESULTS Two hundred and eight internal medicine patients were discharged in 2018, and 252 were discharged in 2019. The median hospital LOS was significantly lower during the intervention period (14.2 days (IQR, 8-23) vs 19 days (IQR, 12-32); p<0.001). In-hospital mortality, 30-day mortality, readmission in 30 days and the number of hospital acquired conditions were the same between groups. Of the 3350 patient days analysed, 1482 (44.2%) were classified as green and 1868 (55.8%) as red. The lack of senior review was the most frequent cause of a red day (42.4%). CONCLUSION The SAFER patient flow bundle and Red2Green days tool implementation were associated with a significant decrease in hospital LOS in a university hospital IMU ward. There is a considerable improvement opportunity for hospital LOS reduction by changing the multidisciplinary team's attitude during patient hospitalisation using these strategies.
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Affiliation(s)
| | - Luciana de Gouvêa Viana
- Departamento de Propedeutica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcus Vinícius Melo de Andrade
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Hospital Sirio-Libanes, Sao Paulo, Brazil
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Soulsby WD, Lawson E, Okumura M, Pantell MS. Socioeconomic Factors Are Associated With Severity of Hospitalization in Pediatric Lupus: An Analysis of the 2016 Kids' Inpatient Database. Arthritis Care Res (Hoboken) 2023; 75:2073-2081. [PMID: 36971263 DOI: 10.1002/acr.25121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/13/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Health disparities in adult lupus, including higher disease severity and activity among those in poverty, have been identified. Similar associations in pediatric lupus have not been clearly established. This study was undertaken to investigate the relationship of income level and other socioeconomic factors with length of stay (LOS) in the hospital and severe lupus features using the 2016 Kids' Inpatient Database (KID). METHODS Lupus hospitalizations were identified in children ages 2-20 years in the 2016 KID using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes (M32). Univariate and multivariate negative binomial regression analyses were used to analyze the association of income level, race and ethnicity, and insurance status with LOS in the hospital. Univariate and multivariate logistic regression analyses were used to analyze the association of the same predictors with the presence of severe lupus features, defined using ICD-10 codes associated with lupus sequelae (e.g., lupus nephritis). RESULTS A total of 3,367 unweighted (4,650 weighted) lupus hospitalizations were identified. Income level was found to be a statistically significant predictor of increased LOS in the hospital for those in the lowest income quartile (adjusted incidence rate ratio 1.12 [95% confidence interval (95% CI) 1.02-1.23]). Black race, "other" race, and public insurance were also associated with severe lupus features (adjusted odds ratio [ORadj ] 1.51 [95% CI 1.11-2.06]; ORadj 1.61 [95% CI 1.01-2.55]; and ORadj 1.51 [95% CI 1.17-2.55], respectively). CONCLUSION Using a nationally representative data set, income level was found to be a statistically significant predictor of LOS in the hospital among those with the lowest reported income, highlighting a potential target population for intervention. Additionally, Black race and public insurance were associated with severe lupus features.
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Amawi H, Arabyat RM, Al-Azzam S, AlZu'bi T, U'wais HT, Hammad AM, Amawi R, Nusair MB. The Length of Hospital Stay of Patients with Venous Thromboembolism: A Cross-Sectional Study from Jordan. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040727. [PMID: 37109685 PMCID: PMC10145113 DOI: 10.3390/medicina59040727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Venous thromboembolism is one of the leading causes of mortality and disability worldwide. Treatment with anticoagulation therapy is essential and requires a delicate approach to select the most appropriate option to improve patient outcomes, including the length of hospital stay (LOS). The aim of this study was to determine the LOS among patients with acute onset of VTE in several public hospitals in Jordan. Materials and Methods: In this study, we recruited hospitalized patients with a confirmed diagnosis of VTE. We reviewed the electronic medical records and charts of VTE admitted patients in addition to a detailed survey to collect the patients' self-reported data. Hospital LOS was categorized into three levels: 1-3 days, 4-6 days, and ≥7 days. An ordered logistic regression model was used to study the significant predictors of LOS. Results: A total of 317 VTE patients were recruited, with 52.4% of them were male and 35.3% aged between 50 and 69 years. Most patients had a deep vein thrombosis (DVT) diagnosis (84.2%), and most of the VTE cases were admitted for the first-time (64.6%). The majority of the patients were smokers (57.2%), overweight/obese (66.3%), and hypertensive (59%). Most of the VTE patients received Warfarin overlapped with low molecular weight heparins as their treatment regimen (>70%). Almost half of the admitted VTE patients (45%) were hospitalized for at least 7 days. Longer LOS was significantly associated with hypertension. Conclusions: We recommend using therapies that have been proven to reduce hospital LOS, such as non-vitamin K antagonist oral anticoagulants or direct oral anticoagulants, to treat VTE patients in Jordan. Additionally, preventing and controlling comorbidities such as hypertension is essential.
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Affiliation(s)
- Haneen Amawi
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Yarmouk University, Irbid 22110, Jordan
| | - Rasha M Arabyat
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Yarmouk University, Irbid 22110, Jordan
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Toqa AlZu'bi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Hamza Tayseer U'wais
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Yarmouk University, Irbid 22110, Jordan
| | - Alaa M Hammad
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan
| | - Ruba Amawi
- The Ministry of Health, Amman 11118, Jordan
| | - Mohammad B Nusair
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Yarmouk University, Irbid 22110, Jordan
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
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Ingabire PM, Nantale R, Sserwanja Q, Nakireka S, Musaba MW, Muyinda A, Tumuhaise C, Namulema E, Bongomin F, Napyo A, Ainembabazi R, Olum R, Munabi I, Kiguli S, Mukunya D. Factors associated with prolonged hospitalization of patients with corona virus disease (COVID-19) in Uganda: a retrospective cohort study. Trop Med Health 2022; 50:100. [PMID: 36578071 PMCID: PMC9795158 DOI: 10.1186/s41182-022-00491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Identification of factors predicting prolonged hospitalization of patients with coronavirus disease (COVID-19) guides the planning, care and flow of patients in the COVID-19 Treatment Units (CTUs). We determined the length of hospital stay and factors associated with prolonged hospitalization among patients with COVID-19 at six CTUs in Uganda. METHODS We conducted a retrospective cohort study of patients admitted with COVID-19 between January and December 2021 in six CTUs in Uganda. We conducted generalized linear regression models of the binomial family with a log link and robust variance estimation to estimate risk ratios of selected exposure variables and prolonged hospitalization (defined as a hospital stay for 14 days or more). We also conducted negative binomial regression models with robust variance to estimate the rate ratios between selected exposures and hospitalization duration. RESULTS Data from 968 participants were analyzed. The median length of hospitalization was 5 (range: 1-89) days. A total of 136/968 (14.1%: 95% confidence interval (CI): 11.9-16.4%) patients had prolonged hospitalization. Hospitalization in a public facility (adjusted risk ratio (ARR) = 2.49, 95% CI: 1.65-3.76), critical COVID-19 severity scores (ARR = 3.24: 95% CI: 1.01-10.42), and malaria co-infection (adjusted incident rate ratio (AIRR) = 0.67: 95% CI: 0.55-0.83) were associated with prolonged hospitalization. CONCLUSION One out of seven COVID-19 patients had prolonged hospitalization. Healthcare providers in public health facilities should watch out for unnecessary hospitalization. We encourage screening for possible co-morbidities such as malaria among patients admitted for COVID-19.
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Affiliation(s)
- Prossie M. Ingabire
- grid.461255.10000 0004 1780 2544Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Ritah Nantale
- grid.448602.c0000 0004 0367 1045Department of Nursing, Busitema University, Tororo, Uganda
| | - Quraish Sserwanja
- Department of Programmes, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan
| | - Susan Nakireka
- grid.461227.40000 0004 0512 5435Department of Medicine, Mengo Hospital, Kampala, Uganda ,grid.442658.90000 0004 4687 3018Department of Medicine and Dentistry, Uganda Christian University, Kampala, Uganda
| | - Milton W. Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda ,grid.448602.c0000 0004 0367 1045Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
| | - Asad Muyinda
- grid.461350.50000 0004 0504 1186Department of Medicine, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Criscent Tumuhaise
- grid.461252.60000 0004 0514 4556Department of Medicine, Our Lady Health of the Sick, Nkozi Hospital, Nkozi, Uganda
| | - Edith Namulema
- grid.461227.40000 0004 0512 5435Covid Task Force Institution, Mengo Hospital, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology, Gulu University, Gulu, Uganda
| | - Agnes Napyo
- grid.448602.c0000 0004 0367 1045Department of Community and Public Health, Busitema Universiy, Tororo, Uganda
| | | | - Ronald Olum
- grid.461255.10000 0004 1780 2544Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Ian Munabi
- grid.11194.3c0000 0004 0620 0548Department of Anatomy, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- grid.11194.3c0000 0004 0620 0548Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - David Mukunya
- grid.448602.c0000 0004 0367 1045Department of Community and Public Health, Busitema Universiy, Tororo, Uganda
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Rate and causes of inappropriate stays and the resulting financial burden in a single specialty burns hospital. BMC Health Serv Res 2022; 22:1538. [PMID: 36527082 PMCID: PMC9758030 DOI: 10.1186/s12913-022-08772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND One of the most important challenges facing hospitals is inappropriate admissions and stays the reduction of which can contribute to a decline in healthcare costs without reducing the quality of services. The aim of this study was to estimate the rate and causes of inappropriate stays and their financial burden in a single specialty burns hospital. METHODS This is mixed methods study conducted in 2021. In the quantitative phase, all medical records of patients admitted to a burn hospital were reviewed and 260 cases were randomly selected. The records were evaluated based on the Appropriateness Evaluation Protocol to estimate the rate and preliminary causes of inappropriate stays and their direct costs. Frequencies and logistic regression were used for the rates and the influential factors in causing inappropriate stay, respectively. In the qualitative phase, 13 senior and middle managers of the hospital were interviewed for their interpretation of the quantitative data and the main causes of inappropriate stays. Qualitative data were analyzed by using Graneheim-Lundman method. RESULTS About 28.5% of the patients had at least 1 day of inappropriate stay and about 6% of the total hospitalization days were inappropriate. Marital status, insurance status, and the length of stay were significantly associated with inappropriate admission (p < 0.05). In addition, the annual inappropriate admission days and the direct cost imposed on the patients were estimated at 1490 days and $ 66,848.17. The main causes of inappropriate stays are categorized under themes of healthcare providers, service recipients, financial issues, extra-organizational features, and equipment. CONCLUSION A significant percentage of patients experience inappropriate admissions. The number of inappropriate stays, which imposes a high cost on patients, can be reduced by considering the standard criteria for appropriate admissions. In addition, hospital officials can prevent inappropriate stays as much as possible and reduce the costs and increase the productivity of hospitals through proper management and planning as well as a regular monitoring of physicians and patients.
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Li H, Tao H, Li G. Predictors and reasons for inappropriate hospitalization days for surgical patients in a tertiary hospital in Wuhan, China: a retrospective study. BMC Health Serv Res 2021; 21:900. [PMID: 34470637 PMCID: PMC8408966 DOI: 10.1186/s12913-021-06845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/02/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Inappropriate hospitalization day (IHD) is recognized as an important indication of the excessive demand for health-care services, especially for surgical patients. We aim to examine the degree of IHDs, predictors associated with higher incidences of IHDs, and reasons for each IHD in different periods of hospitalization. METHODS A total of 4586 hospital days from 408 cases were evaluated by a cross-sectional and retrospective audit program carried out in a tertiary hospital with 5613 beds and 9623 faculty in Wuhan, China. This study used the revised Chinese version of the Appropriateness Evaluation Protocol (C-AEP) to assess IHDs, and the Delay Tool to ascertain each reason for IHDs. A binary logistic regression model was performed to examine the predictors of higher incidences of IHDs. RESULTS The average frequency of IHDs was 23.24 %, and a total of 322 cases (78.92 %) were reported to have experienced at least one IHD. The multivariate analysis showed that patients at the age of 60-69 with respect to under 50, and with overlength of stay were predictors of higher incidences of preoperative IHDs, while admission from outpatient, multiple diagnosis, higher surgical incision level, and overlength of stay were predictors of higher incidence of postoperative IHDs. The most frequent reasons related to health providers for IHDs were doctor's conservative views of patient management and delays in inspection, prescription, appointment, or result report. Patient factors gave rise to nearly a quarter of postoperative IHDs. CONCLUSIONS Findings from this study indicate that measures including paying more attention to the construction of MDT for diagnosis and treatment in general surgery, reducing laboratory turnaround time, dispelling distrust among health-care providers and patients, setting stricter discharge standards and, providing integrated out-of-hospital services could be adopted accordingly to improve the inappropriateness of hospital stays.
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Affiliation(s)
- Hao Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
| | - Hongbing Tao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
| | - Gang Li
- Department of Outpatient Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
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Prolonged hospital length of stay in pediatric trauma: a model for targeted interventions. Pediatr Res 2021; 90:464-471. [PMID: 33184499 DOI: 10.1038/s41390-020-01237-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/17/2020] [Accepted: 10/11/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND In this study, trauma-specific risk factors of prolonged length of stay (LOS) in pediatric trauma were examined. Statistical and machine learning models were used to proffer ways to improve the quality of care of patients at risk of prolonged length of stay and reduce cost. METHODS Data from 27 hospitals were retrieved on 81,929 hospitalizations of pediatric patients with a primary diagnosis of trauma, and for which the LOS was >24 h. Nested mixed effects model was used for simplified statistical inference, while a stochastic gradient boosting model, considering high-order statistical interactions, was built for prediction. RESULTS Over 18.7% of the encounters had LOS >1 week. Burns and corrosion and suspected and confirmed child abuse are the strongest drivers of prolonged LOS. Several other trauma-specific and general pediatric clinical variables were also predictors of prolonged LOS. The stochastic gradient model obtained an area under the receiver operator characteristic curve of 0.912 (0.907, 0.917). CONCLUSIONS The high performance of the machine learning model coupled with statistical inference from the mixed effects model provide an opportunity for targeted interventions to improve quality of care of trauma patients likely to require long length of stay. IMPACT Targeted interventions on high-risk patients would improve the quality of care of pediatric trauma patients and reduce the length of stay. This comprehensive study includes data from multiple hospitals analyzed with advanced statistical and machine learning models. The statistical and machine learning models provide opportunities for targeted interventions and reduction in prolonged length of stay reducing the burden of hospitalization on families.
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Sahiledengle B, Tekalegn Y, Zenbaba D, Woldeyohannes D, Teferu Z. Which Factors Predict Hospital Length-of-Stay for Children Admitted to the Neonatal Intensive Care Unit and Pediatric Ward? A Hospital-Based Prospective Study. Glob Pediatr Health 2020; 7:2333794X20968715. [PMID: 33225021 PMCID: PMC7649955 DOI: 10.1177/2333794x20968715] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/06/2020] [Accepted: 09/30/2020] [Indexed: 02/05/2023] Open
Abstract
Background. The ability to accurately predict hospital length of stay (LOS) or time to discharge could aid in resource planning, stimulate quality improvement activities, and provide evidence for future research and medical practice. This study aimed to determine the predictive factors of time to discharge among patients admitted to the neonatal intensive care unit (NICU) and pediatric ward in Goba referral hospital, Ethiopia. Methods. A facility-based prospective follow up study was conducted for 8 months among 438 patients. Survival analyses were carried out using the Kaplan Meier statistics and Cox regression model. Results. The median length of hospital stay was 7 days (95% confidence interval (CI): 6.45-7.54) and 6 days (95% CI: 5.21-6.78) for patients admitted to NICU and pediatric ward, respectively. In the multivariable Cox regression, the hazard of neonatal patients with less than 37 weeks of gestational age, low birth weight, and those who develop hospital-acquired infection (HAI) after admission had prolonged time to discharge by 54% [adjusted hazard ratio (AHR): 0.46, (95% CI: 0.31-0.66)], 40% [AHR: 0.60, (95% CI: 0.40-0.90)], and 56% [AHR: 0.44, (95% CI: 0.26-0.74)], respectively. The rate of time to discharge among patients who were admitted to the pediatric ward and had HAI delayed discharge time by 49% [AHR: 0.51, (95% CI: 0.30-0.85)] compared to their counterparts. Conclusion. Hospital-acquired infections prolonged hospital stay among neonates and children admitted to the pediatric ward. On a similar note, low gestational age and low birth weight were found to be the independent predictor of longer hospital stay among neonates.
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Affiliation(s)
- Biniyam Sahiledengle
- School of Health Science, Department of Public Health, Madda Walabu University, Robe, Ethiopia
| | - Yohannes Tekalegn
- School of Health Science, Department of Public Health, Madda Walabu University, Robe, Ethiopia
| | - Demisu Zenbaba
- School of Health Science, Department of Public Health, Madda Walabu University, Robe, Ethiopia
| | - Demelash Woldeyohannes
- School of Health Science, Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Zinash Teferu
- School of Health Science, Department of Public Health, Madda Walabu University, Robe, Ethiopia
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The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. J Clin Med 2020; 9:jcm9093055. [PMID: 32971851 PMCID: PMC7564707 DOI: 10.3390/jcm9093055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.
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Nowak M, Lee S, Karbach U, Pfaff H, Groß SE. Short length of stay and the discharge process: Preparing breast cancer patients appropriately. PATIENT EDUCATION AND COUNSELING 2019; 102:2318-2324. [PMID: 31427170 DOI: 10.1016/j.pec.2019.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/16/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Breast cancer is the most common cancer among women worldwide, increasing the relevance of an efficient and successful care process. As length of stay (LOS) in the hospital decreases, patients' satisfaction with the LOS varies. We hypothesize that successful discharge planning can improve this evaluation. METHODS Data of 4,390 female breast cancer patients from a cross-sectional survey was analyzed. The data was collected in 2017 in 86 German hospitals. Logistic regressions were used to test hypotheses. RESULTS The majority of included patients rated their LOS as appropriate. However, patients who felt better prepared for discharge were less likely to rate their stay as too short. A longer stay in the hospital further decreased this likelihood. The effect of LOS was moderated by patient experiences with preparation for discharge. CONCLUSION As hospital LOS decreases, one challenge in allowing patients to feel sufficiently informed and ready to go home is the reduced time for face-to-face consultations. Our results indicate, however, that a strong and thorough discharge planning makes the actual number of days for LOS irrelevant for patient's rating of LOS. PRACTICE IMPLICATIONS The study results underscore the importance of ensuring the quality and thoroughness of the discharge process.
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Affiliation(s)
- Marina Nowak
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany.
| | - Susan Lee
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences of the Technical University Dortmund, Dortmund, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany
| | - Sophie E Groß
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany; LVR-Institute of Health Care Research, LVR Clinic Cologne, Cologne, Germany
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Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Inappropriate Rate of Admission and Hospitalization in the Iranian Hospitals: A Systematic Review and Meta-Analysis. Value Health Reg Issues 2019; 21:105-112. [PMID: 31704488 DOI: 10.1016/j.vhri.2019.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 06/06/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inappropriate admission and hospitalization are types of overuse that impose a financial burden on all health systems, especially in hospitals. OBJECTIVE To analyze the evidence on the inappropriateness of admission and hospitalization in Iranian hospitals. METHODS This study was conducted using PubMed, Embase, Scopus, and Web of Science, as well as Persian databases, including Magiran and Scientific Information Database up to May 2018. Two researchers extracted result of the included studies, independently. We used Cohen's κ statistic for measuring inter-rater agreement. The meta-analyses were conducted based on pooled effect estimates for the rate of admission and hospitalization using the DerSimonian-Laird random-effects model with 95% confidence intervals (CI). RESULTS Seventeen articles met the inclusion criteria. The inter-rater agreement was very good for abstracts and full-texts screening (κ 0.86 and 98, respectively). The overall inappropriate rate was 12.3% (95% CI, 8.4-17.5) and 11.9% (95% CI, 7.7-18.1) for admission and hospitalization, respectively. The inappropriate rate of admission was significantly higher before the Health Sector Evolution Plan (HSEP) than after HSEP (14.6%, 95% CI, 8.6-23.6 before HSEP and 10%, 95% CI, 5.5-17.3 after HSEP), and the inappropriate rate of hospitalization was significantly higher after HSEP than before HESP (9.5%, 95% CI, 5.2-16.7 before HSEP and 16.9%, 95% CI, 8.2-31.7 after HSEP). CONCLUSIONS Adoption standard measures of admission and hospitalization, treating patients in appropriate care centers, and establishing a referral system is essential to reduce the inappropriate admission and hospitalization in Iranian hospitals. Such interventions can lead to a reduction in personnel costs and workload and ultimately increase the productivity of the hospital.
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Affiliation(s)
- Morteza Arab-Zozani
- Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammad Zakaria Pezeshki
- Department of Community and Family Medicine, Social Determinants of Health Research Center, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
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Landeiro F, Roberts K, Gray AM, Leal J. Delayed Hospital Discharges of Older Patients: A Systematic Review on Prevalence and Costs. THE GERONTOLOGIST 2019; 59:e86-e97. [PMID: 28535285 DOI: 10.1093/geront/gnx028] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To determine the prevalence of delayed discharges of elderly inpatients and associated costs. DESIGN AND METHODS We searched Medline, Embase, Global Health, CAB Abstracts, Econlit, Web of Knowledge, EBSCO - CINAHL, The Cochrane Library, Health Management Information Consortium, and SCIE - Social Care Online for evidence published between 1990 and 2015 on number of days or proportion of delayed discharges for elderly inpatients in acute hospitals. Descriptive and regression analyses were conducted. Data on proportions of delayed discharges were pooled using a random effects logistic model and the association of relevant factors was assessed. Mean costs of delayed discharge were calculated in USD adjusted for Purchasing Power Parity (PPP). RESULTS Of 64 studies included, 52 (81.3%) reported delayed discharges as proportions of total hospital stay and 9 (14.1%) estimated the respective costs for these delays. Proportions of delayed discharges varied widely, from 1.6% to 91.3% with a weighted mean of 22.8%. This variation was also seen in studies from the same country, for example, in the United Kingdom, they ranged between 1.6% and 60.0%. No factor was found to be significantly associated with delays. The mean costs of delayed discharge also varied widely (between 142 and 31,935 USD PPP adjusted), reflecting the variability in mean days of delay per patient. IMPLICATIONS Delayed discharges occur in most countries and the associated costs are significant. However, the variability in prevalence of delayed discharges and available data on costs limit our knowledge of the full impact of delayed discharges. A standardization of methods is necessary to allow comparisons to be made, and additional studies are required-preferably by disease area-to determine the postdischarge needs of specific patient groups and the estimated costs of delays.
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Affiliation(s)
- Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Kenny Roberts
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - Alastair Mcintosh Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - José Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
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Miguélez-Chamorro A, Casado-Mora MI, Company-Sancho MC, Balboa-Blanco E, Font-Oliver MA, Román-Medina Isabel I. Advanced practice in case management: An essential element in the new complex chronicity care model. ENFERMERIA CLINICA 2018; 29:99-106. [PMID: 30219620 DOI: 10.1016/j.enfcli.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
The increased prevalence of complex chronic diseases in all stages of life, the progressive aging of the population, the prevalence of multimorbidity, polypharmacy, and loss of autonomy, have given rise to new needs in society. The current model of care is failing to meet these needs in an effective or sustainable way. People with complex chronic diseases are vulnerable, they deteriorate as diseases progress, and they require individualized and coordinated professional care that takes into account the progression of the disease, transitions and people's preferences. It is essential to determine a new care paradigm as a framework for the projects and actions that should be promoted to reach transversal, sustainable and quality care directed at people with complex and advanced chronic diseases in all stages of life. Different studies show that case management is an added value in terms of quality, safety and cost-effectiveness. However, its implementation in Spain is uneven and heterogeneous, and no regulations have yet been developed to give stability to this new nurse figure. The Ministry and the Autonomous Communities now have the responsibility to create regulations and institutionalize the figure of case management nurses/advanced practice nurses, with a clear definition of their professional competences and functions, as has been done in other countries.
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Affiliation(s)
| | | | | | - Edelmiro Balboa-Blanco
- Grupo de trabajo de gestión de casos de la Asociación de Enfermería Familiar y Comunitaria de Catalunya, España
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14
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Unterhuber M, Tomaino M, Brignole M. [Do we need syncope units? : Experience from Bolzano, South Tyrol (Italy)]. Herzschrittmacherther Elektrophysiol 2018; 29:199-203. [PMID: 29761334 DOI: 10.1007/s00399-018-0561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
Syncope is a common cause for presentation to the emergency department. Because of the numerous differential diagnoses which can be life-threatening, it can be a challenging work-up for the physician. This often results in admission rates that are too high and hospital stays that are too long with consequent high costs. Several studies have shown the inferiority of best-clinical practice to an evidence-based approach in syncope work-up, which results in underdiagnosis and often incorrect diagnosis of syncope. The consequences are undirected therapies and subsequently high recurrence rates of syncope, which lead to limited quality of life and readmissions. For this reason, the European Society of Cardiology (ESC) Guidelines for the diagnosis and management of syncope recommend the organization of Syncope Units. Through a standardized and evidence-based approach, the diagnostic and therapeutic work-up can be done in a safe and effective manner, allowing an organized follow-up and further management of patients with syncope. This article summarizes the reasons for the need of syncope units and explains the practical implementation of the guidelines using the example of the Syncope Unit in Bolzano, South Tyrol (Italy).
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Affiliation(s)
- Matthias Unterhuber
- Herzzentrum Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland. .,Regionalkrankenhaus Bozen, L. Böhler-Str. 5, 39100, Bozen, Italien.
| | - Marco Tomaino
- Regionalkrankenhaus Bozen, L. Böhler-Str. 5, 39100, Bozen, Italien
| | - Michele Brignole
- Department of Cardiology, Ospedali Tigullio, 16033, Lavagna, Italien
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15
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Buttigieg SC, Abela L, Pace A. Variables affecting hospital length of stay: a scoping review. J Health Organ Manag 2018; 32:463-493. [DOI: 10.1108/jhom-10-2017-0275] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose
Tertiary hospitals have registered an incremental rise in expenditure mostly because of the increasing demands by ageing populations. Reducing the length of stay (LOS) of patients within tertiary hospitals is one of the strategies, which has been used in the last decades to ensure health care systems’ sustainability. Furthermore, LOS is one of the key performance indicators, which is widely used to assess hospital efficiency. Hence, it is crucial that policy makers use evidence-based practices in health care to aim for optimal LOS. The purpose of this paper is to identify and summarize empirical research that brings together studies on the various variables that directly or indirectly impact on LOS within tertiary hospitals so as to develop a LOS causal systems model.
Design/methodology/approach
This scoping review was guided by the following research question: “What is affecting the LOS of patients within tertiary-level health care?” and by the guidelines specified by Arksey and O’Malley (2005), and by Armstrong et al. (2011). Relevant current literature was retrieved by searching various electronic databases. The PRISMA model provided the process guidelines to identify and select eligible studies.
Findings
An extensive literature search yielded a total of 30,350 references of which 46 were included in the final analysis. These articles yielded variables, which directly/indirectly are linked to LOS. These were then organized according to the Donabedian model – structure, processes and outcomes. The resultant LOS causal model reflects its complexity and confirms the consideration by scholars in the field that hospitals are complex adaptive systems, and that hospital managers must respond to LOS challenges holistically.
Originality/value
This paper illustrates a complex LOS causal model that emerged from the scoping review and may be of value for future research. It also highlighted the complexity of the construct under study.
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16
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Afilalo M, Xue X, Soucy N, Colacone A, Jourdenais E, Boivin JF. Patient Needs, Required Level of Care, and Reasons Delaying Hospital Discharge for Nonacute Patients Occupying Acute Hospital Beds. J Healthc Qual 2018; 39:200-210. [PMID: 28658090 DOI: 10.1111/jhq.12076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study aims to determine the proportion of nonacute patients occupying acute care beds and to describe their needs, the appropriate level of alternative care, and reasons preventing discharge. Data from 952 patients hospitalized in an acute care unit for 30 days were obtained from their medical charts and by consulting with the medical team at two tertiary teaching hospitals. Among them, 333 (35%) were determined nonacute on day 30 of hospitalization. According to the Appropriateness Evaluation Protocol (AEP), 55% had no medical, nursing, or patient needs. Among nonacute patients with AEP needs, 88% were related to nursing/life-support services and 12% related to patient condition factors. Regarding alternative level of care, 186 (56%) were waiting for out-of-hospital resources, of which 36% were waiting for palliative care, 33% for long-term care, 18% for rehabilitation, and 12% for home care. For the remaining 147 (44%) nonacute patients, the alternative resources remained undetermined although acute care was no longer required. Main reasons preventing discharge included unavailability of alternative resources, ongoing assessment to determine appropriate resources, ongoing process with community care, and family/patient education/counseling. Available subacute facilities and community-based care would liberate acute care beds and facilitate their appropriate use.
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17
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Machado JP, Martins M, Leite IDC. [Variation in hospital performance according to payment sources in the states of São Paulo and do Rio Grande do Sul, Brazil]. CAD SAUDE PUBLICA 2016; 32:S0102-311X2016000705006. [PMID: 27462852 DOI: 10.1590/0102-311x00114615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 02/18/2016] [Indexed: 11/22/2022] Open
Abstract
In Brazil, the combined presence of public and private interests in financing and provision of healthcare services stands out clearly in hospital care. Financing arrangements adopted by hospitals (the public Brazilian Unified National Health System - SUS and/or health plans and/or out-of-pocket payment) can affect quality of care. Studies have analyzed the hospital standardized mortality ratio (HSMR) in relation to quality improvements. The objective was to analyze HSMR according to source of payment for the hospitalization and the hospital's financing arrangement. The study analyzed secondary data and causes that accounted for 80% of hospital deaths. HSMR was calculated for each hospital and payment source. Hospitals with worse-than-expected performance (HSMR > 1) were mostly large public hospitals. HSMR was higher in the SUS, including between admissions in the hospital. Despite the study's limitations, the findings point to inequalities in results of care. Efforts are needed to improve the quality of hospital services, regardless of the payment sources.
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Affiliation(s)
| | - Mônica Martins
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Iuri da Costa Leite
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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18
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Lobo E, Ventura T, Navio M, Santabárbara J, Kathol R, Samaniego E, Marco C, Lobo A. Identification of components of health complexity on internal medicine units by means of the INTERMED method. Int J Clin Pract 2015; 69:1377-86. [PMID: 26271926 DOI: 10.1111/ijcp.12721] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/27/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The INTERMED was developed for the early identification of biological, psychological, social and health system factors considered interacting in health complexity. This is defined as the interference with the achievement of expected or desired health and service use outcomes when patients are exposed to standard care. OBJECTIVE The aim of this study was to test the INTERMED's ability to identify 'case' and 'care' complexity, identifying patients that would especially benefit from integrated care. METHODS Observational longitudinal study of Internal medicine in patients in two National Health System hospitals in Spain using the INTERMED (patients scoring ≥ 21 were considered to be 'complex'); the Cumulative Illness Rating Scale (CIRS), a severity of illness assessment; and standard clinical variables. RESULTS Six hundred and fifteen consecutives were included, and the prevalence of health complexity was 27.6%. The greatest differences between patients with and without health complexity were observed in the non-biological domains. Eighty-five per cent of patients with health complexity had non-biological items considered to require timely (immediately or soon) assistance or intervention compared to 30% of those without, nearly a threefold difference. Complex patients had a significantly higher number of medical diagnoses (p = 0.002) and number of psychiatric referrals (p = 0.041), but there were no differences in CIRS scores or lengths of stay. CONCLUSION The INTERMED has the potential to identify a considerable subset of complex internal medicine inpatients for which timely corrective action related to non-biological risk factors not typically uncovered during standard medical evaluations would be considered beneficial.
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Affiliation(s)
- E Lobo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - T Ventura
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
- Servicio de Psiquiatría, Hospital Clínico Universitario, Zaragoza, Spain
| | - M Navio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Servicio de Psiquiatría, Hospital Doce de Octubre, Madrid, Spain
| | - J Santabárbara
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - R Kathol
- Cartesian Solutions, Inc™, Burnsville, MN, USA
- Departments of Internal Medicine and Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - E Samaniego
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain
- Hospital Residencia Profesor Rey Ardid, Zaragoza, Spain
| | - C Marco
- Servicio de Psiquiatría, Hospital Clínico Universitario, Zaragoza, Spain
| | - A Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
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Cournane S, Byrne D, O'Riordan D, Silke B. Factors associated with length of stay following an emergency medical admission. Eur J Intern Med 2015; 26:237-42. [PMID: 25743060 DOI: 10.1016/j.ejim.2015.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/13/2015] [Accepted: 02/14/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospitals are under pressure to use resources in the most efficient manner. We have examined the factors predicting Length of Stay (LOS) in one institution, using a database of all episodes of emergency medical admissions prospectively collected over 12 years. AIM To examine the ability to predict hospital LOS following an emergency medical hospital admission. METHODS All emergency admissions (66,933 episodes; 36,271 patients) to St. James's Hospital, Dublin, Ireland over a 12-year period (2002-2013) were evaluated in relation to LOS. Predictor variables (identified univariately) were entered into a multiple logistic regression model to predict a longer or shorter LOS (bivariate at the median). The data was also modelled as count data (absolute LOS), using zero truncated Poisson regression methodology. Appropriate post-estimation techniques for model fit were then applied to assess the resulting model. RESULTS The major predictors of LOS included Acute Illness Severity (biochemical laboratory score at admission), Charlson co-morbidity, Manchester Triage Category at admission, Diagnosis Related Group, sepsis status (based on blood culture result), and Chronic Disease Score Indicator. The full model to predict a LOS above or below the median had an Area Under Receiver Operating Characteristic (AUROC) of 0.71 (95% CI: 0.70, 0.71). The truncated Poisson model appeared to achieve a good model fit (R(2) statistic=0.76). CONCLUSION Predictor variables strongly correlated with LOS; there were linear increases within categories and summation between variables. More predictor variables may improve model reliability but predicting LOS ranges or quantiles may be more realistic, based on these results.
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Affiliation(s)
- Seán Cournane
- Medical Physics and Bioengineering Department, St. James's Hospital, Dublin 8, Ireland.
| | - Declan Byrne
- Division of Internal Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Deirdre O'Riordan
- Division of Internal Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Bernard Silke
- Division of Internal Medicine, St. James's Hospital, Dublin 8, Ireland
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20
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Specchia ML, Poscia A, Volpe M, Parente P, Capizzi S, Cambieri A, Damiani G, Ricciardi W, De Belvis AG. Does clinical governance influence the appropriateness of hospital stay? BMC Health Serv Res 2015; 15:142. [PMID: 25889675 PMCID: PMC4392497 DOI: 10.1186/s12913-015-0795-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/16/2015] [Indexed: 11/25/2022] Open
Abstract
Background Clinical Governance provides a framework for assessing and improving clinical quality through a single coherent program. Organizational appropriateness is aimed at achieving the best health outcomes and the most appropriate use of resources. The goal of the present study is to verify the likely relationship between Clinical Governance and appropriateness of hospital stay. Methods A cross-sectional study was conducted in 2012 in an Italian Teaching Hospital. The OPTIGOV© (Optimizing Health Care Governance) methodology was used to quantify the level of implementation of Clinical Governance globally and in its main dimensions. Organizational appropriateness was measured retrospectively using the Italian version of the Appropriateness Evaluation Protocol to analyze a random sample of medical records for each clinical unit. Pearson-correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and the Clinical Governance implementation levels. Results 47 Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with almost all the main Clinical Governance dimensions. Adjusted multiple regression analysis resulted in a significant association between the percentage of inappropriate days and the overall Clinical Governance score (β = −0.28; p < 0.001; R-squared = 0.8). EBM and Clinical Audit represented the Clinical Governance dimensions which had the strongest association with organizational appropriateness. Conclusions This study suggests that the evaluation of both Clinical Governance and organizational appropriateness through standardized and repeatable tools, such as OPTIGOV© and AEP, is a key strategy for healthcare quality. The relationship between the two underlines the central role of Clinical Governance, and especially of EBM and Clinical Audit, in determining a rational improvement of appropriateness levels.
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Affiliation(s)
- Maria Lucia Specchia
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | - Andrea Poscia
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. .,Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.
| | - Massimo Volpe
- Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.
| | - Paolo Parente
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | - Silvio Capizzi
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | - Andrea Cambieri
- Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.
| | - Gianfranco Damiani
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | - Walter Ricciardi
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.
| | | | - Antonio Giulio De Belvis
- Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. .,Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.
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Afilalo M, Soucy N, Xue X, Colacone A, Jourdenais E, Boivin JF. Hospital stay on acute care units for non-acute reasons: Effects of patient pre-hospitalization and admission factors. Healthc Manage Forum 2015; 28:34-39. [PMID: 25838569 DOI: 10.1177/0840470414551906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study identifies patient risk factors present prior to an acute hospitalization that are associated with occupying acute care beds for non-acute reasons on the 30th day of a hospitalization. Data from 952 adult patients were obtained, among which 333 (35%) were evaluated as non-acute on their 30th day. Inability to move in and out of the bed, cognitive impairment, receiving home or community healthcare services prior to hospitalization, unavailable family resources, a secondary diagnosis within the mental and behavioural category, and age ≥75 years were found to increase the risk of occupying acute care beds for non-acute reasons, while patients with a feeding tube were less likely to be non-acute at day 30.
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Affiliation(s)
- Marc Afilalo
- Emergency Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nathalie Soucy
- Emergency Department, Jewish General Hospital, Montreal, Quebec, Canada
| | - Xiaoqing Xue
- Emergency Department, Jewish General Hospital, Montreal, Quebec, Canada.
| | | | - Emmanuelle Jourdenais
- Emergency Department, CHUM Notre-Dame Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Jean-François Boivin
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Ghods AA, Khabiri R, Raeisdana N, Ansari M, Hoshmand Motlagh N, Sadeghi M, Zarei E. Predictors of inappropriate hospital stay: experience from Iran. Glob J Health Sci 2014; 7:82-9. [PMID: 25948427 PMCID: PMC4802064 DOI: 10.5539/gjhs.v7n3p82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/07/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Hospital services are the most expensive component of modern health care systems and inappropriate hospital stay is one of the most important challenges facing hospitals in many countries. The purpose of this study was to determine the extent of inappropriate hospital stay and investigate the related factors in Semnan city (Iran). METHODS In this study, the Iranian version of Appropriateness Evaluation Protocol (AEP) was used in a representative sample of 300 hospital admissions and 905 hospital days. Data collection was performed during six weeks in January and February 2014 in four wards (two internal medicine and two surgical wards) of two hospitals in Semnan city (Iran). RESULTS The results showed that 7.4% of admissions and 22.1% of stays have been inappropriate. Inappropriate stays were mainly concerned to the factors, including length of stay, inappropriate admissions, as well as factors related to hospitals. The most frequent causes of unjustifiable days were due to waiting for diagnostic or therapeutic procedures (35.1%), and 20.6% delay in discharge of patients by physicians due to conservative medical policy. CONCLUSION In conclusion, this study confirms the existence of inappropriate hospital stays which may be due to patient characteristics and hospital factors. The most unjustifiable reasons for inappropriate hospital stay were related to internal processes of hospital, which mostly could be prevented through appropriate management Therefore, some steps must be taken to decrease inappropriate hospital stay and preserve hospital resources for patients who need them.
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