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Verma AA, Guo Y, Kwan JL, Lapointe-Shaw L, Rawal S, Tang T, Weinerman A, Razak F. Characteristics of short general internal medicine hospital stays: a multicentre cross-sectional study. CMAJ Open 2019; 7:E47-E54. [PMID: 30692151 PMCID: PMC6349563 DOI: 10.9778/cmajo.20180181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Short hospital stays may represent opportunities to avert unnecessary admissions or expedite inpatient care. To inform the design of interventions that target patients with potentially avoidable hospital admissions or brief stays, we examined the patient, physician and situational characteristics associated with short stays among patients admitted to general internal medicine wards and describe the use of hospital resources by these patients. METHODS This was a multicentre cross-sectional study conducted between Apr. 1, 2012, and Mar. 31, 2015, at 5 teaching hospitals in Toronto. We included all general internal medicine admissions through the emergency department. We examined patient, physician and situational predictors of a short hospital stay, which was defined as the patient's being discharged home alive in 2 possible time windows: less than 24 hours, or 72 hours or less. RESULTS The final study sample included 56 055 admissions and 37 700 unique patients. Patients discharged in less than 24 hours and in 72 hours or less accounted for 4245 (7.6%) and 13 442 (31.6%) admissions, respectively. After we controlled for patient factors, patients of female physicians were less likely than those of male physicians to have stays lasting less than 24 hours (adjusted odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86) or 72 hours or less (adjusted OR 0.82, 95% CI 0.79-0.86). Patients admitted at night or on a weekday were significantly more likely than those admitted at other times to have stays lasting less than 24 hours (night: adjusted OR 2.73, 95% CI 2.44-3.06; weekday: adjusted OR 1.26, 95% CI 1.17-1.36) or 72 hours or less (night: adjusted OR 1.29, 95% CI 1.22-1.37, weekday: adjusted OR 1.05, 95% CI 1.01-1.10). Among stays lasting less than 24 hours and 24-72 hours, intravenously administered medications were ordered for 2788 (65.7%) and 10 722 (79.8%) patients, respectively, and computed tomography scans were performed for 1561 (36.8%) and 5354 (39.1%) patients, respectively. INTERPRETATION Short general internal medicine hospital stays were common and were associated with patient, physician and situational factors. Interventions to avert hospital admission or reduce length of stay may be more effective if they are accessible outside typical working hours and provide access to intravenous therapy and radiological investigations.
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Affiliation(s)
- Amol A Verma
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass.
| | - Yishan Guo
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Janice L Kwan
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Lauren Lapointe-Shaw
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Shail Rawal
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Terence Tang
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Adina Weinerman
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Fahad Razak
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
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Nguyen MT, Woodman RJ, Hakendorf P, Thompson CH, Faunt J. Can the simple clinical score usefully predict the mortality risk and length of stay for a recently admitted patient? AUST HEALTH REV 2015; 39:522-527. [PMID: 25817909 DOI: 10.1071/ah14123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 02/04/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of the present study was to determine whether an aggregate simple clinical score (SCS) has a role in predicting the imminent mortality and in-hospital length of stay (LOS) of newly admitted, acutely unwell General Medical in-patients. METHODS Data were collected prospectively from adult patients admitted through an Acute Medical Unit between February and August 2013. Using logistic regression analysis before and after adjustment for age, the SCS was assessed for its association with LOS and mortality, including 30-day mortality, just for those patients for full resuscitation. Changes in sensitivity and specificity after adding SCS to age as a predictor, as well as the change in the net reclassification index, were determined using the predicted probabilities from the logistic regression models. RESULTS The SCS was superior to age in predicting mortality of any patient within 30 days. It did not assist in predicting 30-day mortality for those patients who were for full resuscitation. The ability of the SCS to predict long stay (> 72h) remained relatively low (64%) and was inferior to published rates achieved by bedside clinician assessment (74%-82%). CONCLUSION There was no useful prospective role for the SCS in predicting LOS and mortality of in-patients newly admitted to a General Medicine service.
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Affiliation(s)
- Minh T Nguyen
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, SA 5005, Australia. Email
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia. Email
| | - Paul Hakendorf
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia. Email
| | - Campbell H Thompson
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, SA 5005, Australia. Email
| | - Jeff Faunt
- Department of General Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Email
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