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.  KJ, Preen 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).. However, in the multivariate logistic regression model, intensive care unit requirement or admission was not a predictor of ExProH (P = .22). 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). This database confirmed the findings of our multivariate analysis about nonmedical reasons being the cause of ExProH.  C, Weigelt  JA Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. 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). Level of evidence. Conflict of Interest Disclosures: None reported. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Drafting of the manuscript: Hwabejire, Kaafarani, Imam, Velmahos. In-hospital operational delays were the reason for ExProH in 26%, and payer-related issues were the reason in 7%. Background and objectives: The average length of stay (ALOS) in a hospital is used to gauge the efficiency of a healthcare facility.  JE. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. 2014 Aug;23(4):384-401. doi: 10.1177/1054773813487373. 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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… J Asthma. Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. 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).  G, Chapuis 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. We want to embed a Excessively prolonged hospitalization and hospital cost. Lorch SA, Zhang X, Rosenbaum PR, Evan-Shoshan O, Silber JH.  AA, Bass  AA, Zimmerman  EJ.  T,  |   C, O'Dougherty Summary statistics were used to describe continuous variables, while proportions were calculated for categorical variables. Conclusions: 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.  LP, Ferguson  GP, Lagoe  RJ, Johnson Medical complications of ischemic stroke and length of hospital stay: experience in Seattle, Washington. 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). 2004 Oct;114(4):e400-8.  PH, Bokey Baseline Comorbidities for Excessively Prolonged Hospitalization vs Non–Excessively Prolonged Hospitalization, Table 3. 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. The study was approved by our institutional review board. Reduction in length of hospital stay is a veritable target in reducing the overall costs of health care. 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. Acquisition of data: Hwabejire, Kaafarani, Imam, Solis. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Of 3237 patients, 155 (5%) had ExProH. Fifty-six percent of ExProH patients had surgery compared with 39% of non-ExProH patients. Level I academic trauma center. 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. 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. Payer-related issues included delays resulting from medical necessity reviews by the health insurance provider or appeals when coverage was denied.  |   LS, Chu 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. Get free access to newly published articles. Main Outcomes and Measures   WS, Jones Pediatrics.  OF, Sinclair 2013;148(10):956–961. An alternative strategy for studying adverse events in medical care. Adult trauma patients admitted between January 1, 2006, and December 31, 2010. NIH This difference was not statistically significant (P = .10). 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. Geographic variation in resource use for coronary artery bypass surgery. Background and perioperative risk factors for prolonged hospital stay after resection of colorectal cancer.  LB, Stocking 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. 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. The trauma registry, billing databases, and medical records of trauma admissions were reviewed. NLM  KJ, Rasmussen They were also more likely to be self-payers or covered by Medicare/Medicaid.  ED, Study concept and design: Hwabejire, Kaafarani, Solis, Sullivan, DeMoya, Velmahos. 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.  EL. And the average hospital stay for an elderly person is $12,000, according to the Agency for Healthcare Research and Quality. In contrast to our hypothesis (and to common belief), patients with and without ExProH had similar injury severity, physiological compromise, and comorbidities. In this study, prolonged hospitalization was arbitrarily defined as a hospital LOS longer than 10 days.  S, eds. Excessively Long Hospital Stays After Trauma Are Not Related to the Severity of Illness: Let’s Aim to the Right Target! 1999; 8:336–343.  ER, Peterson Design  J Stroke Cerebrovasc Dis. Potentially Preventable Complications is a system for categorizing and evaluating inpatient hospital complications. In-Hospital Complication Rates for Excessively Prolonged Hospitalization vs Non–Excessively Prolonged Hospitalization, Table 4. The only independent predictors of ExProH were issues related to insurance coverage and discharge disposition. Agency for Healthcare Research and Quality. To identify the causes of excessively prolonged hospitalization (ExProH) in trauma patients. In the Commonwealth of Massachusetts with about 59 446 trauma discharges per year,21 this indicates hospital cost savings of approximately $130 000 000.  et al. 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). Setting We used data of 61 Dutch hospitals. This site needs JavaScript to work properly. Andrews et al2 showed that the probability of experiencing an adverse event increased about 6% for each day of hospital stay. Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis. Among ExProH patients, ExProH was caused by difficulties in transfer to a rehabilitation facility in 47%. A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay. Terms of Use| Schimmel This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients.  SM, MacKenzie Long Stay Patients Long stays are NOT always inappropriate but prolonged hospitalisation is associated with significant social, economic, physical and psychological burden. We used χ2 or Fisher exact tests for comparisons between categorical variables. 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. Conclusions Prolonged ICU stay is an important predictor of adverse immediate, short-term, and long-term outcomes after cardiac operations. Complications are conditions arising during the hospital stay and comorbidities are preexisting conditions, both affecting treatment received and/or prolonging LOS. Privacy Policy| 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). 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). Langenbrunner Reasons for delayed discharge of trauma patients. © 2020 American Medical Association. 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. Clin Nurs Res. The Diagnosis Related Group (DRG) of each patient was reviewed and the trim point for LOS for that DRG was determined. Analysis and interpretation of data: Hwabejire, Kaafarani, Verge, Alam, Velmahos. The reasons for discharge delays were clinical in only 20% of the cases. Executive Office of Health and Human Services, Commonwealth of Massachusetts.  JC, Cashin Around one-fifth of beds are occupied by patients who have already been in hospital for three weeks. Factors associated with length of stay for pediatric asthma hospitalizations. Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. doi:10.1001/jamasurg.2013.2148.  SJ, Boldy Long-stay patients account for about 8% of overnight admissions, have an average length of stay (LoS) of about 40 days. Morris Allman 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. Skip Navigation This application is not fully accessible to users whose browsers do not support or have Cascading Style Sheets (CSS) disabled. A prolonged ICU stay was defined as being equal to or longer than 10 days. Clinical deterioration was the reason in only 20%. Equivalent lengths of stay of pediatric patients hospitalized in rural and nonrural hospitals. Compared with the PLOS model, the PPOLOS model better predicted risk of prolonged hospital stay. Importance  This means that ExProH could be reduced from 5% to 1%. Establishing an ICD-10 code based SARI-surveillance in Germany - description of the system and first results from five recent influenza seasons. Spratt N, Wang Y, Levi C, Ng K, Evans M, Fisher J. HHS Other variables examined include intensive care unit requirement, ventilation requirement, head injuries, and need for an operation. Inpatient complications were identified by the association of the complication's postoperative date with the patient’s surgical discharge date. Trauma patients return to productivity.  MP.  TB, A prospective study of predictors of prolonged hospital stay and disability after stroke.  N, Bartolucci Weintraub Of 3237 patients, 155 (5%) had ExProH. de Jong Excessively prolonged hospitalization and hospital cost. Cost-reduction efforts should target operational bottlenecks between acute and postacute care. cognitive impairment (delirium or dementia). Epidemiol Infect. Pediatrics. to download free article PDFs, Based on the ExProH reasons identified, we believe that LOS and cost can be reduced without compromising the quality of trauma care delivered. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association.  AA, Thomas  R, Cohen 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. Cowper However, there is a small minority of patients with unreasonably long hospital stays (ExProH). Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work? 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.  MJ, Dent  |  Setting  The specific reasons are displayed in Table 5. The primary outcome was ExProH. The increase in cost (and payments) did not result in increased profit for the hospital. These factors are directly related to the subject of our study, which identifies important opportunities for reducing the hospital LOS in trauma patients. Minor and major complications were stronger predictors of prolonged hospital stay than preoperative demographic and disease parameters.  R, Bates In this database, the case managers track potentially avoidable hospital days and the possible causes, including operational, payer-related, and clinical issues.  C.  Determinants of prolonged length of hospital stay after coronary bypass surgery. The main limitation of our study is the inability to determine the exact details related to the administrative bottlenecks that led to ExProH. 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. The financial burden of such unnecessary hospitalization is heavy. Discharge Before Return to Respiratory Baseline in Children With Neurologic Impairment. Study supervision: Kaafarani, DeMoya, Alam, Velmahos. Clinical reasons included delays in discharge because of changes in the patient’s clinical condition that required further tests or longer in-hospital observation. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon’s National Cardiac Database. 2020 May-Jun;20(4):508-515. doi: 10.1016/j.acap.2019.09.008. Table 1 compares the characteristics and clinical course of ExProH and non-ExProH patients. It is reasonable to assume that patients stay in the hospital longer because they are sicker. An additional strength was the analysis of the potentially avoidable hospital days database, which is populated prospectively by our case managers. Epub 2018 Jul 26. 16 It is unclear whether these complications prolonged hospital stay or a long hospital stay for nonmedical reasons encouraged the development of complications. Published Online: August 21, 2013. doi:10.1001/jamasurg.2013.2148.  et al; IHD Port Investigators. 2015 Jun;52(5):471-7. doi: 10.3109/02770903.2014.984843.  K, Feldman In-hospital mortality was lower for ExProH patients. The generalization of these findings to other facilities is unknown.  DP, McCaul JAMA Surg. A strength of our study was the definition of ExProH. Trauma patients who stay for excessively prolonged periods in the hospital are not necessarily severely injured, physiologically compromised, or old. These included demographic characteristics, injury-related characteristics, clinical information (hospital LOS, comorbidities, in-hospital complications, and in-hospital mortality), and financial information (hospital cost and the net margin, the latter being a generally used measure of cost containment and profitability). septic arthritis, endophthalmitis, and meningitis in patients. Other studies have argued that comorbidities and complications prolong hospital stay.  EL, Craver Diagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure. If the person or family members anticipate problems, they should discuss preventive measures with staff members. Conclusions and Relevance  Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. We expect this information to be interesting to policy makers who are striving to understand the medical system and its associated cost. About 80% of the ExProH cases were not related to clinical issues and therefore could potentially be avoided (Table 5). Patients with ExProH were compared with patients without ExProH. Lack of rehabilitation or other subacute care facility bed was the main reason for delay in 83% of the patients. System-related issues, not severity of illness, prolong hospital stay excessively. 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.  DW, Franz  PE, Murphy Other arbitrary cutoff points of prolonged hospital stay have been used in similar studies.3,8.  JA. 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. Massachusetts injury data facts and highlights.  ER, Peterson Kaushal Epub 2014 Nov 21. Every day in hospital is a precious day away from home. Accessibility Statement, Table 1. Background: Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. 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. All Rights Reserved. Adult trauma patients admitted between January 1, 2006, and December 31, 2010. 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. © 2020 American Medical Association.  PA, DeLong Treatment Study. Rickard The cost of care for ExProH patients tripled compared with that of their non-ExProH counterparts.  ED, Coombs 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. Copyright © 2015 by the American Academy of Pediatrics. 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.  EM. 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. Of 3237 trauma patients admitted during the study period, 155 (5%) experienced ExProH. Trauma patients admitted to other services (orthopedic, neurosurgical, etc) were excluded from the study. Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens …  C, Soukup 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). Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. Cost-reduction efforts should target operational bottlenecks between acute and postacute care. Despite these limitations, our study uncovers the true causes of ExProH. Please enable it to take advantage of the complete set of features! The causes of ExProH were explored in a unique potentially avoidable days database, used by our hospital’s case managers to track discharge delays. ... KHN’s coverage of aging and long-term care issues is … Health care efficiency measures: identification, categorization, and evaluation. High-cost users of hospital beds in Western Australia: a population-based record linkage study. The hazards of hospitalization. Conclusion. Administrative, technical, or material support: Verge, Sullivan, Velmahos.  DR.  Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. We explored the utility of the UL-LOS indicator. From beginning till the end of the study (figure 6), it was found that patients with complications (30.70%) stayed longer in hospital.  PS, Burst 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). 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. All analyses were performed using IBM SPSS Statistics 20 software (IBM Corp). Epub 2019 Oct 21. Critical revision of the manuscript for important intellectual content: Hwabejire, Solis, Verge, Sullivan, DeMoya, Alam, Velmahos. 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). Effective care planning promoting patient and carer involvement is associated with lower LOS, better health outcomes, greater satisfaction and reduced risk of adverse Others with severe COVID-19 may develop complications, require rehabilitation after a hospital stay, or both. 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. Methods: The trim point is 9 days, and a hospital stay longer than this is considered ExProH. Ryskina KL, Dynan L, Stein R, Fieldston E, Palakshappa D. Acad Pediatr. 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 Type of study. Patients with ExProH had a net margin lower than that of non-ExProH patients by nearly 50%. 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. LAWriter Ohio Laws and Rules. The Importance of Length of Stay in Hospitals. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Objectives To assess the impact of minor, major and individual complications on prolonged length of hospital stay in patients with colorectal cancer (CRC) after surgery using multivariate models. Health care policy makers should shift the focus toward the right target to reduce excessive hospital stays and cost in trauma patients.  J, Cauley 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. The remaining discharges were excessively delayed because of difficulties in rehabilitation facility placement (47%), in-hospital operational delays (26%), or payer-related issues (7%). It has been estimated that each year, more than 13,000 deaths are associated with UTIs.5 Brasel 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. COVID-19 is an emerging, rapidly evolving situation. Level III. There is little doubt that the patient’s physiological condition and the postoperative morbidity play a crucial role in the duration of hospital stay. 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. 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.  et al. Forty-three percent of ExProH patients required intensive care unit admission compared with 32% of non-ExProH patients (P = .01). In addition, the ExProH group had a net margin of −45.2%, compared with 2.6% for the non-ExProH group (higher is better). Additionally, these patients represent a significant economic problem on public health systems and their families. Thirty-two percent of ExProH patients had head injuries compared with 26% of non-ExProH patients. Calver Univariate and multivariate analyses were performed to determine independent predictors of ExProH. 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. There were no differences in race/ethnicity between the 2 groups. We hypothesize that the burden of injury, significant comorbidities, and postoperative complications are the major causes of ExProH. Buda S, Tolksdorf K, Schuler E, Kuhlen R, Haas W. BMC Public Health. Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study.  ED, 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). "Far and away, the most serious hospital risk is a medication error," says Carolyn … 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.  PP. Objective   JD, Westert 2019 Nov;69(5):570-574. doi: 10.1097/MPG.0000000000002426.  DB, Alexia Epub 2013 May 15. Interactive effects of age and respiratory virus on severe lower respiratory infection. Main Outcome and Measure Hospitals’ risk-adjusted extended LOS rates, defined as the proportion of patients with a hospital stay greater than the 75th percentile for the entire cohort. 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). Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. All Rights Reserved.  R, Groenewegen Irshad 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. 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. Andrews Optimal surgical and medical care have major roles in surgical CRC patients. 2018 Oct;146(14):1861-1869. doi: 10.1017/S0950268818002017. For more information … Our website uses cookies to enhance your experience. 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. In addition to the 2 outcomes, we identified and grouped the reasons for ExProH.  RM, Goode  J, Guyton Results: Customize your JAMA Network experience by selecting one or more topics from the list below. However, when having surgery was entered into the logistic regression model, the odds ratio was 0.60 (95% CI, 0.41-0.87; P = .03), implying that having surgery reduces the odds of exceeding the trim point LOS, ie, ExProH, by 40%. Additionally, these patients represent a significant economic problem on public health systems and their families. The specific discharge practices and hurdles of our region’s health care system may be less pertinent to other parts of the country. This can allow comparison with results from other centers. Curr Opin Pediatr. To identify the causes of excessively prolonged hospitalization (ExProH) in trauma patients. doi: 10.1542/peds.2004-0891. For this, we used a unique database maintained by the Case Management Department.  Jr, Sanchez  G, Morin Effect of a clinical pathway on length of stay and cost of pediatric inpatient asthma admissions: an integrative review. Accepted for Publication: February 28, 2013. 2007 Mar;119(3):487-94. doi: 10.1542/peds.2006-2353.  JE. Peterson Patel PV, Pantell MS, Heyman MB, Verstraete S. J Pediatr Gastroenterol Nutr. 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. Hospital Stays Can Lead To Physical Harm.  JF, Baslaim Crossref Medline Google Scholar; 32.  KA. Although physicians should participate in all aspects of a patient’s care, there is little they can do to improve these specific issues. Kramer 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). Participants  The causes recorded by the case managers were based on individual judgments without any consensus process. Hwabejire JO, Kaafarani HMA, Imam AM, et al. 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. A variety of potential causes of delays, such as the weekend phenomenon, were not explored. 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. Reduction in length of hospital stay is a veritable target in reducing the overall costs of health care.  et al. These were difficult to evaluate retrospectively, but we have now designed a prospective study to capture the necessary information. The trauma registry, billing databases, and medical records of trauma admissions were reviewed. In addition to the physical impact of … 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). 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. Prolonged, inappropriate hospital stay after patients’ eligibility for discharge from internal medicine departments is a world-wide health-care systems’ problem. 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). Statistical significance was defined as P < .05.  J, Brameld Psychological distress could further delay patients’ recovery as stress delays wound healing and compromises immunity.  PA, DeLong Lagoe Steuart R, Tan R, Melink K, Chinchilla S, Warniment A, Shah SS, Thomson J. J Hosp Med. The risk of physical harm runs through even the safest … Costs of adverse events in intensive care units. Cowper Like others,17,18 we have found that in our institution these few patients (5% of trauma admissions) account for approximately 70% of the unnecessary hospital cost (J.V., M.A.D., H.B.A., G.C.V., Alice Gervasini, PhD, and David R. King, MD, unpublished data, June 2011), and for this reason ExProH patients present a special interest to health care providers and administrators.

prolonged hospital stay complications

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