prolonged hospital stay complications

December 2, 2020 in Uncategorized

Setting We used data of 61 Dutch hospitals. In a classic prospective study of more than 1000 patients with documented in-hospital complications in a university medical service, Schimmel1 concluded that the risk of complication was directly related to the length of time spent in the hospital. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). For LRI hospitalizations (n = 204 950), risks for prolonged LOS and complications were decreased with each year of age (AOR 0.98, 95% CI 0.97-0.98; AOR 0.95, 95% CI 0.94-0.96, respectively) and increased in children with chronic conditions (AOR 9.86, 95% CI 9.03-10.76; AOR 56.22, 95% CI 46.60-67.82, respectively).  KA. The causes of ExProH were explored in a unique potentially avoidable days database, used by our hospital’s case managers to track discharge delays.  PA, DeLong An alternative strategy for studying adverse events in medical care. Establishing an ICD-10 code based SARI-surveillance in Germany - description of the system and first results from five recent influenza seasons. Both groups had similar Injury Severity Scores, Revised Trauma Scores, baseline comorbidities, and in-hospital complication rates. We used χ2 or Fisher exact tests for comparisons between categorical variables.  C, Krizek In the Commonwealth of Massachusetts with about 59 446 trauma discharges per year,21 this indicates hospital cost savings of approximately $130 000 000. 2020 May-Jun;20(4):508-515. doi: 10.1016/j.acap.2019.09.008.  C, Weigelt Univariate and multivariate analyses were performed to determine independent predictors of ExProH. It found that a one-night stay in hospital carried a 3.4 per cent risk of an adverse drug reaction, an 11.1 per cent risk of an infection and a 0.4 per cent chance of an ulcer. We hypothesize that the burden of injury, significant comorbidities, and postoperative complications are the major causes of ExProH. Crossref Medline Google Scholar; 32.  T, The reasons for discharge delays were clinical in only 20% of the cases.  DP, McCaul The hospital length of stay (LOS) has been identified as one of the major drivers of resource consumption in multiple ways.3-5 Hospital cost increases because beds and human personnel are occupied by ExProH patients and because of the rise in associated adverse events.6 In addition, there is a societal cost due to ExProH patients’ lost economic productivity. Administrative, technical, or material support: Verge, Sullivan, Velmahos. Corresponding Author: George C. Velmahos, MD, PhD, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, 165 Cambridge St, Ste 810, Boston, MA 02114 (gvelmahos@partners.org). Lorch SA, Zhang X, Rosenbaum PR, Evan-Shoshan O, Silber JH. 2019 Nov;69(5):570-574. doi: 10.1097/MPG.0000000000002426. Trauma patients who stay for excessively prolonged periods in the hospital are not necessarily severely injured, physiologically compromised, or old. This database confirmed the findings of our multivariate analysis about nonmedical reasons being the cause of ExProH. The risk of physical harm runs through even the safest … Accepted for Publication: February 28, 2013. Importance  J Asthma. Cost-reduction efforts should target operational bottlenecks between acute and postacute care. Study concept and design: Hwabejire, Kaafarani, Solis, Sullivan, DeMoya, Velmahos. Treatment Study. The specific discharge practices and hurdles of our region’s health care system may be less pertinent to other parts of the country. In this database, the case managers track potentially avoidable hospital days and the possible causes, including operational, payer-related, and clinical issues. Their hospital LOS was more than 3 times longer and hospital cost was 3 times higher (mean, $54 646 vs $18 444, respectively; P < .001) (Table 1). A prolonged ICU stay was defined as being equal to or longer than 10 days. Additionally, these patients represent a significant economic problem on public health systems and their families. © 2020 American Medical Association. From beginning till the end of the study (figure 6), it was found that patients with complications (30.70%) stayed longer in hospital. Author Contributions: Velmahos had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Depression Predicts Prolonged Length of Hospital Stay in Pediatric Inflammatory Bowel Disease.  C, O'Dougherty The trauma registry, billing databases, and medical records of trauma admissions were reviewed. 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The patients with ExProH compared with non-ExProH patients were older (mean [SD] age, 53 [21] vs 47 [22] years, respectively; System-related issues, not severity of illness, prolong hospital stay excessively. The trauma registry, billing databases, and medical records of trauma admissions were reviewed. septic arthritis, endophthalmitis, and meningitis in patients. According to the Institute of Medicine’s Crossing the Quality Chasm,12,13 health care systems in the 21st century should aim to be “safe, effective, patient-centered, timely, efficient, and equitable.”12 In the current health care climate that revolves around improving quality and reducing cost, timeliness (defined by the Institute of Medicine as “reducing waits and sometimes harmful delays for both those who receive and those who give care”12) and efficiency of care (defined by the Institute of Medicine as “avoiding waste, in particular waste of equipment, supplies, ideas, and energy”12) are increasingly receiving close scrutiny. For more information … Data from the trauma registry were supplemented by information from the electronic medical records and the hospital’s billing records.  JE. Requirement for mechanical ventilation was similar in both the ExProH and non-ExProH groups (37 of 155 patients [24%] vs 723 of 3082 patients [23%], respectively; P = .91) and so was not tested in the multivariate model. Independent Predictors of Excessively Prolonged Hospitalization Status. A variety of potential causes of delays, such as the weekend phenomenon, were not explored. These factors are directly related to the subject of our study, which identifies important opportunities for reducing the hospital LOS in trauma patients. In the surgical community, there is a prevailing belief that the patient’s physiological condition, as determined by preexisting comorbidities and postoperative complications, is the major determinant of ExProH.3,7,8 A logical conclusion would then be that ExProH can be reduced by more attentive medical care to optimize patients for operation and avoid subsequent complications.  et al. The trim point for LOS is defined as 2 SDs above the mean LOS for cases within a DRG.10,11 Insurers use this trim point to determine prolonged hospitalization,10,11 and we used the same value to define ExProH. Effective care planning promoting patient and carer involvement is associated with lower LOS, better health outcomes, greater satisfaction and reduced risk of adverse The only independent predictors of ExProH were issues related to insurance coverage and discharge disposition. Conclusions Prolonged ICU stay is an important predictor of adverse immediate, short-term, and long-term outcomes after cardiac operations. doi:10.1001/jamasurg.2013.2148. The trim point is 9 days, and a hospital stay longer than this is considered ExProH. Lack of rehabilitation or other subacute care facility bed was the main reason for delay in 83% of the patients. LAWriter Ohio Laws and Rules. Trauma patients return to productivity. Health care policy makers should shift the focus toward the right target to reduce excessive hospital stays and cost in trauma patients.  SJ, Boldy However, many existing approaches are flawed because the assumptions of what cause excessive length of stay are incorrect; we methodically identified the right targets in this study. Andrews The main limitation of our study is the inability to determine the exact details related to the administrative bottlenecks that led to ExProH. Variability in cost of coronary bypass surgery in New York State: potential for cost savings. J Clin Neurosci. Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens … Kaushal Study supervision: Kaafarani, DeMoya, Alam, Velmahos. Accessibility Statement, Table 1. Baseline Comorbidities for Excessively Prolonged Hospitalization vs Non–Excessively Prolonged Hospitalization, Table 3. Around one-fifth of beds are occupied by patients who have already been in hospital for three weeks. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Because the net margin is a measure of both profitability and cost control, the implication of our findings is that ExProH is a major driver of increased consumption of hospital resources and health care costs, while producing a negative financial impact on trauma centers. This difference was not statistically significant (P = .10). Epub 2018 Jul 26. cognitive impairment (delirium or dementia). Drafting of the manuscript: Hwabejire, Kaafarani, Imam, Velmahos. The generalization of these findings to other facilities is unknown. Reduction in length of hospital stay is a veritable target in reducing the overall costs of health care.  WS, Jones The patients with ExProH compared with non-ExProH patients were older (mean [SD] age, 53 [21] vs 47 [22] years, respectively; P = .001), were more likely to have blunt trauma (92% vs 84%, respectively; P = .03), were more likely to be self-payers (16% vs 11%, respectively; P = .02) or covered by Medicare/Medicaid (41% vs 30%, respectively; P = .002), were more likely to be discharged to post–acute care facilities than home (65% vs 35%, respectively; P < .001), and had higher hospitalization cost (mean, $54 646 vs $18 444, respectively; P < .001). Excessively prolonged hospitalization (ExProH) is associated with significant clinical risks and increased cost.1-5 These clinical risks include nosocomial infections, deep venous thrombosis, disuse atrophy, adverse drug reactions, medication errors, and multiple other adverse events. There is great pressure to decrease hospital stays and, based on the earlier-mentioned argument, physicians are primarily responsible to do so.9 This study aims to identify trauma patients with ExProH and explore the reasons for it. Kramer Patient Characteristics for Excessively Prolonged Hospitalization vs Non–Excessively Prolonged Hospitalization, Table 2. Please enable it to take advantage of the complete set of features! An additional strength was the analysis of the potentially avoidable hospital days database, which is populated prospectively by our case managers. This can allow comparison with results from other centers. This means that ExProH could be reduced from 5% to 1%.  C.  Determinants of prolonged length of hospital stay after coronary bypass surgery.  PE, Murphy Reasons related to severity of illness or medical care are commonly believed to be the main causes for prolonged hospital stays.14-16 Our study shows that delays in discharge are typically not caused by medical factors. A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay. Clipboard, Search History, and several other advanced features are temporarily unavailable.  G, Morin  LP, Ferguson Results: Curr Opin Pediatr. Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work? Optimal surgical and medical care have major roles in surgical CRC patients. Design  Reasons for delayed discharge of trauma patients.  J, Brameld The hazards of hospitalization. Statistical significance was defined as P < .05. People who cannot adequately care for themselves are more likely to have longer stays in hospital and end up being sent to a nursing home after discharge. Patel PV, Pantell MS, Heyman MB, Verstraete S. J Pediatr Gastroenterol Nutr. Adult trauma patients admitted between January 1, 2006, and December 31, 2010.  DR.  Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Other arbitrary cutoff points of prolonged hospital stay have been used in similar studies.3,8. "Far and away, the most serious hospital risk is a medication error," says Carolyn … The causes recorded by the case managers were based on individual judgments without any consensus process. Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. Excessively Long Hospital Stays After Trauma Are Not Related to the Severity of Illness: Let’s Aim to the Right Target! Nevertheless, the extent to which such surplus hospital stays are associated with infectious complications, their time frame of appearance and their long-term implications was not previously addressed. Cost-reduction efforts should target operational bottlenecks between acute and postacute care.  AA, Thomas Complications and Deaths when patients admitted to the hospital for treatment of a medical problem sometimes get other serious injuries or complications, and may even die. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions). Because it's difficult to predict long-term outcomes from the new COVID-19 virus, scientists are looking at the long-term effects seen in related viruses, such as the virus that causes severe acute respiratory syndrome (SARS)..  LS, Chu If the person or family members anticipate problems, they should discuss preventive measures with staff members. We explored the utility of the UL-LOS indicator. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Summary statistics were used to describe continuous variables, while proportions were calculated for categorical variables. As opposed to the preexisting variable and confusing definitions of prolonged hospital stay,3,7,8 we determined ExProH objectively according to the trim point. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. And the average hospital stay for an elderly person is $12,000, according to the Agency for Healthcare Research and Quality. They were also more likely to be self-payers or covered by Medicare/Medicaid. Costs of adverse events in intensive care units. Conflict of Interest Disclosures: None reported.  PS, Burst  RJ, Johnson  PP. Irshad In-hospital operational delays were the reason for ExProH in 26%, and payer-related issues were the reason in 7%.  JA 2017 Jun 30;17(1):612. doi: 10.1186/s12889-017-4515-1. In addition to the physical impact of … Morris There is little doubt that the patient’s physiological condition and the postoperative morbidity play a crucial role in the duration of hospital stay. Cross-sectional study of hospitalizations of patients <18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. Table 1 compares the characteristics and clinical course of ExProH and non-ExProH patients. The remaining discharges were excessively delayed because of difficulties in rehabilitation facility placement (47%), in-hospital operational delays (26%), or payer-related issues (7%). Setting   JM. Other studies have argued that comorbidities and complications prolong hospital stay. Diagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure. The ExProH patients were older, more likely to have blunt rather than penetrating trauma, and more likely to be discharged to post–acute care facilities rather than home compared with non-ExProH patients.  DW, Franz Schimmel Acquisition of data: Hwabejire, Kaafarani, Imam, Solis.  ED, Excessively prolonged hospitalization has significant financial implications for patients, insurers, and trauma centers. COVID-19 is an emerging, rapidly evolving situation.  PH, Bokey Epub 2013 May 15.  JA. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. Similarly, Irshad et al20 found that both medical and nonmedical reasons prolonged the hospital stay in a thoracic surgery service, with lack of home support (10.2% of patients) and the unavailability of convalescent facilities (7.1% of patients) being the main social reasons for delayed discharge.  TB, Steuart R, Tan R, Melink K, Chinchilla S, Warniment A, Shah SS, Thomson J. J Hosp Med. Trauma patients admitted to other services (orthopedic, neurosurgical, etc) were excluded from the study. The Importance of Length of Stay in Hospitals.  R, Cohen 2004 Oct;114(4):e400-8. Brasel Ryskina KL, Dynan L, Stein R, Fieldston E, Palakshappa D. Acad Pediatr. System-related issues, not severity of illness, prolong hospital stay excessively.  Jr, Sanchez The average length of stay (ALOS) in a hospital is used to gauge the efficiency of a healthcare facility. We expect this information to be interesting to policy makers who are striving to understand the medical system and its associated cost. We used multivariable logistic regression models to identify factors associated with prolonged LOS (>90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death). Of 3237 trauma patients admitted during the study period, 155 (5%) experienced ExProH. Health care efficiency measures: identification, categorization, and evaluation.  et al; IHD Port Investigators. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI).  R, Bates  KJ, Rasmussen To identify the causes of excessively prolonged hospitalization (ExProH) in trauma patients. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. NIH Adult trauma patients admitted between January 1, 2006, and December 31, 2010. These were difficult to evaluate retrospectively, but we have now designed a prospective study to capture the necessary information. The risk of postoperative complications and prolonged hospital stay may significantly be higher for children with pre-operative pulmonary disease, prolonged operative time, and history of ineffective rigid bronchoscopy. 2015 Jun;52(5):471-7. doi: 10.3109/02770903.2014.984843. Patients with ExProH had a net margin lower than that of non-ExProH patients by nearly 50%.  EJ. Effect of a clinical pathway on length of stay and cost of pediatric inpatient asthma admissions: an integrative review. The causes of ExProH were explored in a unique potentially avoidable days database, used by our hospital’s case managers to track discharge delays. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 2013;148(10):956-961. doi:10.1001/jamasurg.2013.2148.  KJ, Preen Patients with ExProH were compared with patients without ExProH. Andrews et al2 showed that the probability of experiencing an adverse event increased about 6% for each day of hospital stay. Complications are conditions arising during the hospital stay and comorbidities are preexisting conditions, both affecting treatment received and/or prolonging LOS. For example, the accepted average hospital LOS for a fracture of the forearm without complications and comorbidities for a patient older than 17 years (DRG 251, grouper version 23) is 3 days.  SM, MacKenzie Background: Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. Potentially Preventable Complications is a system for categorizing and evaluating inpatient hospital complications.  ER, Peterson  |   G, Chapuis A prospective study of predictors of prolonged hospital stay and disability after stroke. All Rights Reserved. Additionally, these patients represent a significant economic problem on public health systems and their families.  JC, Cashin Analysis and interpretation of data: Hwabejire, Kaafarani, Verge, Alam, Velmahos. One notable finding in this study was that PTCA complications traditionally considered to be minor, such as uncomplicated abrupt vessel closure or the need for blood transfusions unrelated to bypass surgery, were associated with excess lengths of hospital stay equivalent to those for major PTCA complications. J Stroke Cerebrovasc Dis. It has been estimated that each year, more than 13,000 deaths are associated with UTIs.5 Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. The comparison of the prolonged stay in hospital between patients who experienced complication such as wound infection and patients without complication was significance (p-value 0.00).  GP, Lagoe There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. However, in the multivariate logistic regression model, intensive care unit requirement or admission was not a predictor of ExProH (P = .22). Clin Nurs Res. The primary outcome was ExProH. Prolonged preoperative hospital stay is a risk factor for complications after emergency colectomy for severe colitis S. A. L. Bartels Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands Prasad N, Trenholme AA, Huang QS, Thompson MG, Pierse N, Widdowson MA, Wood T, Seeds R, Taylor S, Grant CC, Newbern EC; SHIVERS team. Previous Presentation: This study was presented at the 93rd Annual Meeting of the New England Surgical Society; September 23, 2012; Rockport, Maine; and is published after peer review and revision. Fifty-six percent of ExProH patients had surgery compared with 39% of non-ExProH patients. Medication Errors. Objective  Inpatient hospital complications and lengths of stay: a short report. Thirty-two percent of ExProH patients had head injuries compared with 26% of non-ExProH patients. A strength of our study was the definition of ExProH. Payer-related issues included delays resulting from medical necessity reviews by the health insurance provider or appeals when coverage was denied. If the person or family members anticipate problems, they should discuss preventive measures with staff members. In the multivariate analysis, the independent predictors of ExProH were discharge to a rehabilitation facility, discharge to other types of post–acute care facility, and insurance status that was self-pay or Medicare/Medicaid (Table 4). Minor and major complications were stronger predictors of prolonged hospital stay than preoperative demographic and disease parameters. High-cost users of hospital beds in Western Australia: a population-based record linkage study.  EL. There were no differences in race/ethnicity between the 2 groups. 2013;148(10):956–961. JAMA Surg. Allman Executive Office of Health and Human Services, Commonwealth of Massachusetts. Lower respiratory infections in children. Peterson  S, eds. Similar conclusions were reached by Brasel et al,19 who examined 120 trauma patients for discharge delays, defined as “a discharge-ready patient not discharged within 24 h.”19 The authors found no difference in injury severity, age, and comorbidities between the delayed and nondelayed groups. Psychological distress could further delay patients’ recovery as stress delays wound healing and compromises immunity.  JR, Rothschild In-Hospital Complication Rates for Excessively Prolonged Hospitalization vs Non–Excessively Prolonged Hospitalization, Table 4. Geographic variation in resource use for coronary artery bypass surgery.  JD, Westert Length of stay (LOS) is an important measure of resource utilization as patients with prolonged LOS disproportionately account for the consumption of more hospital resources [].Prolonged LOS, which is defined as inpatient stay that exceeds the expected LOS for a certain procedure [], unnecessarily utilizes hospital beds, contributing to capacity shortage. For asthma hospitalizations(n = 85 320), risks for both prolonged LOS and complications were increased with each year of age (adjusted odds ratio [AOR] 1.06, 95% confidence interval [CI] 1.05-1.07; AOR 1.05, 95% CI 1.03-1.07, respectively for each outcome) and in children with chronic conditions (AOR 4.87, 95% CI 4.15-5.70; AOR 21.20, 95% CI 15.20-29.57, respectively). Excessively prolonged hospitalization was defined by the standard method used by insurers, which is a hospital stay that exceeds the Diagnosis Related Group–based trim point. Main Outcomes and Measures  Skip Navigation This application is not fully accessible to users whose browsers do not support or have Cascading Style Sheets (CSS) disabled.  MP. Terms of Use| In-hospital mortality was lower for ExProH patients. The national average for a hospital stay is 4.5 days, according to the Agency for Healthcare Research and Quality, at an average cost of $10,400 per day. Level I academic trauma center. Additionally, we recorded the patients’ discharge disposition (home, post–acute care facility [including rehabilitation facility, long-term care, skilled nursing facility, transitional care unit, psychiatric units, hospice, and others], in-hospital death, and self-discharge against medical advice). 1999; 8:336–343. Although the PTCA complications themselves were related to several baseline clinical and angiographic variables, the individual baseline variables in this cohort of patients had limited ability to predict prolong… 16 It is unclear whether these complications prolonged hospital stay or a long hospital stay for nonmedical reasons encouraged the development of complications. Similarly, there were no differences in the prevalence of comorbidities (Table 2) or the incidence of in-hospital complications (Table 3) between the 2 groups. Conclusions: Type of study. 2020 Sep;15(9):531-537. doi: 10.12788/jhm.3394. In addition, the ExProH group had a net margin of −45.2%, compared with 2.6% for the non-ExProH group (higher is better). 2014 Aug;23(4):384-401. doi: 10.1177/1054773813487373. Langenbrunner Among ExProH patients, ExProH was caused by difficulties in transfer to a rehabilitation facility in 47%. There were no differences between the ExProH and non-ExProH groups in Injury Severity Score (mean [SD], 18 [12] vs 16 [11], respectively; P = .10), physiology on admission as measured by the Revised Trauma Score (mean [SD], 7.6 [7.0] vs 8.3 [6.8], respectively; P = .19) or the weighted Revised Trauma Score (mean [SD], 4.4 [5.5] vs 5.0 [5.2], respectively; P = .17), and probability of survival (mean [SD], −0.53 [2.6] vs −0.29 [2.4], respectively; P = .22).  R, Groenewegen Excessively prolonged hospitalization and hospital cost. Other studies have argued that comorbidities and complications prolong hospital stay.16 It is unclear whether these complications prolonged hospital stay or a long hospital stay for nonmedical reasons encouraged the development of complications. Definitions and DRG reporting requirements. Conclusions and Relevance   AA, Zimmerman The financial burden of such unnecessary hospitalization is heavy. Medical complications of ischemic stroke and length of hospital stay: experience in Seattle, Washington. Objective Surgical complications may affect patients psychologically due to challenges such as prolonged recovery or long-lasting disability. Interactive effects of age and respiratory virus on severe lower respiratory infection. Although physicians should participate in all aspects of a patient’s care, there is little they can do to improve these specific issues. Inpatient complications were identified by the association of the complication's postoperative date with the patient’s surgical discharge date. Discharge Before Return to Respiratory Baseline in Children With Neurologic Impairment.  PA, DeLong People who cannot adequately care for themselves are more likely to have longer stays in hospital and end up being sent to a nursing home after discharge. Independent predictors of mortality were discharge to a rehabilitation facility (odds ratio = 4.66; 95% CI, 2.71-8.00; P < .001) or other post–acute care facility (odds ratio = 5.04; 95% CI, 2.52-10.05; P < .001) as well as insurance type that was Medicare/Medicaid (odds ratio = 1.70; 95% CI, 1.06-2.72; P = .03) or self-pay (odds ratio = 2.43; 95% CI, 1.35-4.37; P = .003). ... KHN’s coverage of aging and long-term care issues is … Epub 2019 Oct 21. Based on the ExProH reasons identified, we believe that LOS and cost can be reduced without compromising the quality of trauma care delivered. 2018 Oct;146(14):1861-1869. doi: 10.1017/S0950268818002017. Clinical reasons included delays in discharge because of changes in the patient’s clinical condition that required further tests or longer in-hospital observation. Pediatrics. Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis. Long Stay Patients Long stays are NOT always inappropriate but prolonged hospitalisation is associated with significant social, economic, physical and psychological burden. Weintraub Cowper  EL, Craver  VF, Dorval  JE.  AA, Bass  N, Bartolucci Calver Excessively prolonged hospitalization and hospital cost. Critical revision of the manuscript for important intellectual content: Hwabejire, Solis, Verge, Sullivan, DeMoya, Alam, Velmahos. Background and objectives: All trauma patients aged 18 years or older who were admitted to the trauma service of the Massachusetts General Hospital, a level I academic trauma center, between January 1, 2006, and December 31, 2010, were retrospectively identified through our trauma registry. Factors associated with length of stay for pediatric asthma hospitalizations.  EM.  OF, Sinclair  J, Cauley Pediatrics. About 80% of the ExProH cases were not related to clinical issues and therefore could potentially be avoided (Table 5). Multiple variable analysis revealed prolonged ICU stay to be an independent predictor of prolonged hospital stay, higher hospital mortality, and poorer long-term survival (all p < 0.001). Our website uses cookies to enhance your experience. Data regarding prolonged length of hospital stay (PLOS) and in-hospital mortality are paramount to evaluate efficiency and quality of surgical care as well as for rational resource utilization, allocation, and administration. Despite these limitations, our study uncovers the true causes of ExProH. Of 3237 patients, 155 (5%) had ExProH. All Rights Reserved. Others with severe COVID-19 may develop complications, require rehabilitation after a hospital stay, or both. Operational issues included the following: delays in scheduling surgery even if all preoperative tests had been completed and informed consent was signed; delays in scheduling or interpretation of required diagnostic tests; cancellations of scheduled procedures typically because of delays in diagnostic test interpretation; lack of timely response by consultants; or nonclinical, noninsurance, patient-related issues that were not resolved on time prior to discharge (eg, lack of family preparation for home care or failure of a patient’s guardian to arrive). However, many existing approaches are flawed because the assumptions of what cause excessive length of stay are incorrect; we methodically identified the right targets in this study. 2003 Feb;15(1):121-6. doi: 10.1097/00008480-200302000-00020. Lagoe For this, we used a unique database maintained by the Case Management Department. In this study, prolonged hospitalization was arbitrarily defined as a hospital LOS longer than 10 days. Equivalent lengths of stay of pediatric patients hospitalized in rural and nonrural hospitals. Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study. doi: 10.1542/peds.2004-0891. To identify the causes of excessively prolonged hospitalization (ExProH) in trauma patients. Get the latest public health information from CDC: https://www.coronavirus.gov. Hospital Stays Can Lead To Physical Harm.  et al. Epub 2014 Nov 21. Cowper However, there is a small minority of patients with unreasonably long hospital stays (ExProH). The Diagnosis Related Group (DRG) of each patient was reviewed and the trim point for LOS for that DRG was determined. Level of evidence. Published Online: August 21, 2013. doi:10.1001/jamasurg.2013.2148. Massachusetts injury data facts and highlights.  ED, Coombs Results  In addition to the 2 outcomes, we identified and grouped the reasons for ExProH. Although some of the information is still crude and lacks the specific granularity that would allow us to identify the precise details leading to ExProH, we were able to group the different causes in broad categories. Risks for prolonged LOS for asthma were increased in large hospitals (AOR 1.67, 95% CI 1.32-2.11) and urban-teaching hospitals (AOR 1.62, 95% CI 1.33-1.97).  et al.  |  Level III. Customize your JAMA Network experience by selecting one or more topics from the list below. Agency for Healthcare Research and Quality. The national list of 16 HACs was developed through a comprehensive process that included: Reviews of the literature; Clinical engagement; Testing of the concept with public and private hospitals. In our institution with 2500 trauma admissions per year, this means a reduction in cost from $6 830 750 to $1 366 150, a significant financial benefit to the hospital. © 2020 American Medical Association. Forty-three percent of ExProH patients required intensive care unit admission compared with 32% of non-ExProH patients (P = .01). They simply stay in the hospital because of unresolved insurance issues, difficult-to-find rehabilitation beds, and in-hospital operational breakdowns. Reduction in length of hospital stay is a veritable target in reducing the overall costs of health care. Methods: Background and perioperative risk factors for prolonged hospital stay after resection of colorectal cancer. Rickard Weintraub et al7 identified preprocedural variables such as age, elective vs emergency status, angina class, ejection fraction, and sex as well as postoperative factors like wound infection, pneumonia, arrhythmias, neurologic events, and postoperative infarction as determinants of prolonged hospital stay following coronary bypass surgery. Every day in hospital is a precious day away from home. HHS In contrast to our hypothesis (and to common belief), patients with and without ExProH had similar injury severity, physiological compromise, and comorbidities.  JF, Baslaim Compared with the PLOS model, the PPOLOS model better predicted risk of prolonged hospital stay. Of 3237 patients, 155 (5%) had ExProH. We want to embed a  MJ, Dent NLM Comparisons between continuous variables were performed using t test for normally distributed data or the Mann-Whitney U test for data that were not normally distributed. This site needs JavaScript to work properly. Get free access to newly published articles.  J, Guyton USA.gov. Conclusion. All analyses were performed using IBM SPSS Statistics 20 software (IBM Corp). Hospital-acquired complications list. Clinical deterioration was the reason in only 20%.  C, Soukup Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. Buda S, Tolksdorf K, Schuler E, Kuhlen R, Haas W. BMC Public Health. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon’s National Cardiac Database. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error.  |  In most cases, ExProH was related to administrative issues, predominantly the inability to place a patient in an appropriate rehabilitation facility, as well as to operational and insurance issues. Complications associated with CAUTI cause discomfort to the patient, prolonged hospital stay, and increased cost and mortality4. Get the latest research from NIH: https://www.nih.gov/coronavirus. It is reasonable to assume that patients stay in the hospital longer because they are sicker. Other variables examined include intensive care unit requirement, ventilation requirement, head injuries, and need for an operation.  LB, Stocking The cost of care for ExProH patients tripled compared with that of their non-ExProH counterparts. Spratt N, Wang Y, Levi C, Ng K, Evans M, Fisher J. Long-stay patients account for about 8% of overnight admissions, have an average length of stay (LoS) of about 40 days. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. In another example, the average hospital LOS for a patient with major chest trauma with complications and comorbidities (DRG 083, grouper version 23) is 6 days and the trim point is 24 days. Hospital stay beyond this period is considered ExProH.

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