Other arbitrary cutoff points of prolonged hospital stay have been used in similar studies.3,8. Of 3237 trauma patients admitted during the study period, 155 (5%) experienced ExProH. In addition to the physical impact of … 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). Univariate and multivariate analyses were performed to determine independent predictors of ExProH.  SJ, Boldy Patients with ExProH had a net margin lower than that of non-ExProH patients by nearly 50%. ... KHN’s coverage of aging and long-term care issues is … The increase in cost (and payments) did not result in increased profit for the hospital.  EL. Cost-reduction efforts should target operational bottlenecks between acute and postacute care. Kramer 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). 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). JAMA Surg.  ER, Peterson We used multivariable logistic regression models to identify factors associated with prolonged LOS (>90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death). Cowper Lack of rehabilitation or other subacute care facility bed was the main reason for delay in 83% of the patients. Geographic variation in resource use for coronary artery bypass surgery. 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). Baseline Comorbidities for Excessively Prolonged Hospitalization vs Non–Excessively Prolonged Hospitalization, Table 3. Rickard It is reasonable to assume that patients stay in the hospital longer because they are sicker. The causes of ExProH were explored in a unique potentially avoidable days database, used by our hospital’s case managers to track discharge delays. 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. Patients with ExProH were compared with patients without ExProH.  JD, Westert Thirty-two percent of ExProH patients had head injuries compared with 26% of non-ExProH patients. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. A prospective study of predictors of prolonged hospital stay and disability after stroke. The average length of stay (ALOS) in a hospital is used to gauge the efficiency of a healthcare facility. 2018 Oct;146(14):1861-1869. doi: 10.1017/S0950268818002017. Excessively prolonged hospitalization and hospital cost. In addition to the 2 outcomes, we identified and grouped the reasons for ExProH. In this study, prolonged hospitalization was arbitrarily defined as a hospital LOS longer than 10 days. The specific reasons are displayed in Table 5. Crossref Medline Google Scholar; 32. Trauma patients return to productivity.  C.  Determinants of prolonged length of hospital stay after coronary bypass surgery. Data from the trauma registry were supplemented by information from the electronic medical records and the hospital’s billing records. 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. The main limitation of our study is the inability to determine the exact details related to the administrative bottlenecks that led to ExProH. An additional strength was the analysis of the potentially avoidable hospital days database, which is populated prospectively by our case managers. 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%. 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. 2017 Jun 30;17(1):612. doi: 10.1186/s12889-017-4515-1.  MP. We explored the utility of the UL-LOS indicator.  PE, Murphy  GP, Lagoe  PA, DeLong 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. 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). These were difficult to evaluate retrospectively, but we have now designed a prospective study to capture the necessary information. Statistical significance was defined as P < .05.  OF, Sinclair  J, Brameld Steuart R, Tan R, Melink K, Chinchilla S, Warniment A, Shah SS, Thomson J. J Hosp Med. 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.  AA, Thomas This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. 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. Terms of Use|  JA Type of study. 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. 2013;148(10):956–961. Langenbrunner In-Hospital Complication Rates for Excessively Prolonged Hospitalization vs Non–Excessively Prolonged Hospitalization, Table 4. 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.  et al. The generalization of these findings to other facilities is unknown. Published Online: August 21, 2013. doi:10.1001/jamasurg.2013.2148. We hypothesize that the burden of injury, significant comorbidities, and postoperative complications are the major causes of ExProH.  PH, Bokey  RM, Goode Please enable it to take advantage of the complete set of features! In addition, the ExProH group had a net margin of −45.2%, compared with 2.6% for the non-ExProH group (higher is better). Level of evidence. Reduction in length of hospital stay is a veritable target in reducing the overall costs of health care. Additionally, these patients represent a significant economic problem on public health systems and their families. "Far and away, the most serious hospital risk is a medication error," says Carolyn …  MJ, Dent Spratt N, Wang Y, Levi C, Ng K, Evans M, Fisher J. The cost of care for ExProH patients tripled compared with that of their non-ExProH counterparts. Conclusions and Relevance  Skip Navigation This application is not fully accessible to users whose browsers do not support or have Cascading Style Sheets (CSS) disabled.  JF, Baslaim  AA, Zimmerman Effect of a clinical pathway on length of stay and cost of pediatric inpatient asthma admissions: an integrative review. 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. 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). 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). Get free access to newly published articles.  WS, Jones  |  For more information … Pediatrics. Setting We used data of 61 Dutch hospitals. Inpatient hospital complications and lengths of stay: a short report. Long-stay patients account for about 8% of overnight admissions, have an average length of stay (LoS) of about 40 days. The trim point is 9 days, and a hospital stay longer than this is considered ExProH.  |  Accessibility Statement, Table 1. 2020 May-Jun;20(4):508-515. doi: 10.1016/j.acap.2019.09.008. Hwabejire JO, Kaafarani HMA, Imam AM, et al. An alternative strategy for studying adverse events in medical care. The risk of physical harm runs through even the safest … NLM System-related issues, not severity of illness, prolong hospital stay excessively. Level III. It has been estimated that each year, more than 13,000 deaths are associated with UTIs.5 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. This means that ExProH could be reduced from 5% to 1%.  LS, Chu 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). Our website uses cookies to enhance your experience. Background: Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization.  DW, Franz Inpatient complications were identified by the association of the complication's postoperative date with the patient’s surgical discharge date. Diagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure. Schimmel They were also more likely to be self-payers or covered by Medicare/Medicaid. 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. And the average hospital stay for an elderly person is $12,000, according to the Agency for Healthcare Research and Quality. The primary outcome was ExProH. Establishing an ICD-10 code based SARI-surveillance in Germany - description of the system and first results from five recent influenza seasons.  PS, Burst 2003 Feb;15(1):121-6. doi: 10.1097/00008480-200302000-00020. Excessively prolonged hospitalization has significant financial implications for patients, insurers, and trauma centers. 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. Methods: Medical complications of ischemic stroke and length of hospital stay: experience in Seattle, Washington. Design  doi:10.1001/jamasurg.2013.2148. 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).  et al. The only independent predictors of ExProH were issues related to insurance coverage and discharge disposition. 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. There is little doubt that the patient’s physiological condition and the postoperative morbidity play a crucial role in the duration of hospital stay. Acquisition of data: Hwabejire, Kaafarani, Imam, Solis. Patel PV, Pantell MS, Heyman MB, Verstraete S. J Pediatr Gastroenterol Nutr. We used χ2 or Fisher exact tests for comparisons between categorical variables. Drafting of the manuscript: Hwabejire, Kaafarani, Imam, Velmahos. In this database, the case managers track potentially avoidable hospital days and the possible causes, including operational, payer-related, and clinical issues.  G, Chapuis 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. 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.  DP, McCaul Results:  ER, Peterson Despite these limitations, our study uncovers the true causes of ExProH. Lorch SA, Zhang X, Rosenbaum PR, Evan-Shoshan O, Silber JH. Health care policy makers should shift the focus toward the right target to reduce excessive hospital stays and cost in trauma patients. Epub 2018 Jul 26. Buda S, Tolksdorf K, Schuler E, Kuhlen R, Haas W. BMC Public Health. Potentially Preventable Complications is a system for categorizing and evaluating inpatient hospital complications. Background and objectives: Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 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. In contrast to our hypothesis (and to common belief), patients with and without ExProH had similar injury severity, physiological compromise, and comorbidities. Irshad Kaushal  ED, 1999; 8:336–343. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Copyright © 2015 by the American Academy of Pediatrics. About 80% of the ExProH cases were not related to clinical issues and therefore could potentially be avoided (Table 5). Depression Predicts Prolonged Length of Hospital Stay in Pediatric Inflammatory Bowel Disease. Setting  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… Fifty-six percent of ExProH patients had surgery compared with 39% of non-ExProH patients. 2014 Aug;23(4):384-401. doi: 10.1177/1054773813487373. 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. 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.  ED, Objective  Clinical deterioration was the reason in only 20%.  LB, Stocking 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.  JE. All Rights Reserved. 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. 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 reasons for discharge delays were clinical in only 20% of the cases. Calver 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. Effective care planning promoting patient and carer involvement is associated with lower LOS, better health outcomes, greater satisfaction and reduced risk of adverse Psychological distress could further delay patients’ recovery as stress delays wound healing and compromises immunity.  DB, Alexia 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. Adult trauma patients admitted between January 1, 2006, and December 31, 2010. 2004 Oct;114(4):e400-8. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon’s National Cardiac Database.  KJ, Rasmussen Agency for Healthcare Research and Quality.  C, Weigelt Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. Massachusetts injury data facts and highlights. Objective Surgical complications may affect patients psychologically due to challenges such as prolonged recovery or long-lasting disability. 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. Forty-three percent of ExProH patients required intensive care unit admission compared with 32% of non-ExProH patients (P = .01). 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. Epub 2013 May 15. Pediatrics. This difference was not statistically significant (P = .10). Factors associated with length of stay for pediatric asthma hospitalizations.  Jr, Sanchez  et al. The Diagnosis Related Group (DRG) of each patient was reviewed and the trim point for LOS for that DRG was determined. 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. Cowper By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association. Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis. Conclusions: Interactive effects of age and respiratory virus on severe lower respiratory infection. From beginning till the end of the study (figure 6), it was found that patients with complications (30.70%) stayed longer in hospital. Minor and major complications were stronger predictors of prolonged hospital stay than preoperative demographic and disease parameters. 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. Brasel  R, Groenewegen The financial burden of such unnecessary hospitalization is heavy. Conflict of Interest Disclosures: None reported. HHS Morris Excessively Long Hospital Stays After Trauma Are Not Related to the Severity of Illness: Let’s Aim to the Right Target! © 2020 American Medical Association. Clipboard, Search History, and several other advanced features are temporarily unavailable. For this, we used a unique database maintained by the Case Management Department. 16 It is unclear whether these complications prolonged hospital stay or a long hospital stay for nonmedical reasons encouraged the development of complications. This site needs JavaScript to work properly. 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. Hospital stay beyond this period is considered ExProH. 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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). Peterson 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). 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). Based on the ExProH reasons identified, we believe that LOS and cost can be reduced without compromising the quality of trauma care delivered. 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. 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. 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. Of 3237 patients, 155 (5%) had ExProH. Costs of adverse events in intensive care units. Around one-fifth of beds are occupied by patients who have already been in hospital for three weeks. Excessively prolonged hospitalization and hospital cost.  C, O'Dougherty Although physicians should participate in all aspects of a patient’s care, there is little they can do to improve these specific issues. 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. Weintraub The trauma registry, billing databases, and medical records of trauma admissions were reviewed.  |  Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. 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.  JE. All Rights Reserved. In the Commonwealth of Massachusetts with about 59 446 trauma discharges per year,21 this indicates hospital cost savings of approximately $130 000 000.  G, Morin Trauma patients admitted to other services (orthopedic, neurosurgical, etc) were excluded from the study.  VF, Dorval 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).. A strength of our study was the definition of ExProH.  EL, Craver Study concept and design: Hwabejire, Kaafarani, Solis, Sullivan, DeMoya, Velmahos. USA.gov. septic arthritis, endophthalmitis, and meningitis in patients. Administrative, technical, or material support: Verge, Sullivan, Velmahos. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. In-hospital mortality was lower for ExProH patients.  RJ, Johnson 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. Curr Opin Pediatr. Every day in hospital is a precious day away from home. Compared with the PLOS model, the PPOLOS model better predicted risk of prolonged hospital stay. NIH Medication Errors.  PP. 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. Participants  LAWriter Ohio Laws and Rules.  EM. 2015 Jun;52(5):471-7. doi: 10.3109/02770903.2014.984843.  et al; IHD Port Investigators. 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. Among ExProH patients, ExProH was caused by difficulties in transfer to a rehabilitation facility in 47%. 2019 Nov;69(5):570-574. doi: 10.1097/MPG.0000000000002426. 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. 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.  PA, DeLong Accepted for Publication: February 28, 2013. Patient Characteristics for Excessively Prolonged Hospitalization vs Non–Excessively Prolonged Hospitalization, Table 2.  S, eds. Lagoe Other variables examined include intensive care unit requirement, ventilation requirement, head injuries, and need for an operation. We want to embed a 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. Optimal surgical and medical care have major roles in surgical CRC patients. Get the latest research from NIH: https://www.nih.gov/coronavirus. to download free article PDFs,  KA. 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. A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay. Variability in cost of coronary bypass surgery in New York State: potential for cost savings. 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). If the person or family members anticipate problems, they should discuss preventive measures with staff members. If the person or family members anticipate problems, they should discuss preventive measures with staff members.  J, Cauley © 2020 American Medical Association. Privacy Policy| Independent Predictors of Excessively Prolonged Hospitalization Status. Table 1 compares the characteristics and clinical course of ExProH and non-ExProH patients. Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study. The specific discharge practices and hurdles of our region’s health care system may be less pertinent to other parts of the country. 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). Importance  Summary statistics were used to describe continuous variables, while proportions were calculated for categorical variables. Other studies have argued that comorbidities and complications prolong hospital stay. 2020 Sep;15(9):531-537. doi: 10.12788/jhm.3394. To identify the causes of excessively prolonged hospitalization (ExProH) in trauma patients. Long Stay Patients Long stays are NOT always inappropriate but prolonged hospitalisation is associated with significant social, economic, physical and psychological burden. Epub 2014 Nov 21. Payer-related issues included delays resulting from medical necessity reviews by the health insurance provider or appeals when coverage was denied.  R, Bates There were no differences in race/ethnicity between the 2 groups.  C, Soukup Allman de Jong The remaining discharges were excessively delayed because of difficulties in rehabilitation facility placement (47%), in-hospital operational delays (26%), or payer-related issues (7%). Complications associated with CAUTI cause discomfort to the patient, prolonged hospital stay, and increased cost and mortality4. Health care efficiency measures: identification, categorization, and evaluation.  EJ.  N, Bartolucci Trauma patients who stay for excessively prolonged periods in the hospital are not necessarily severely injured, physiologically compromised, or old. 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.  ED, Coombs  JC, Cashin This can allow comparison with results from other centers. Hospital-acquired complications list. In-hospital operational delays were the reason for ExProH in 26%, and payer-related issues were the reason in 7%. Critical revision of the manuscript for important intellectual content: Hwabejire, Solis, Verge, Sullivan, DeMoya, Alam, Velmahos.  T, The causes of ExProH were explored in a unique potentially avoidable days database, used by our hospital’s case managers to track discharge delays.  K, Feldman Definitions and DRG reporting requirements. To identify the causes of excessively prolonged hospitalization (ExProH) in trauma patients. Lower respiratory infections in children. Conclusion.  TB, doi: 10.1542/peds.2004-0891. However, there is a small minority of patients with unreasonably long hospital stays (ExProH). We expect this information to be interesting to policy makers who are striving to understand the medical system and its associated cost. Others with severe COVID-19 may develop complications, require rehabilitation after a hospital stay, or both. Hospital Stays Can Lead To Physical Harm. Additionally, these patients represent a significant economic problem on public health systems and their families. A prolonged ICU stay was defined as being equal to or longer than 10 days. Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Of 3237 patients, 155 (5%) had ExProH. Clinical reasons included delays in discharge because of changes in the patient’s clinical condition that required further tests or longer in-hospital observation. cognitive impairment (delirium or dementia). 2007 Mar;119(3):487-94. doi: 10.1542/peds.2006-2353.  C, Krizek Both groups had similar Injury Severity Scores, Revised Trauma Scores, baseline comorbidities, and in-hospital complication rates. J Asthma. 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. Andrews et al2 showed that the probability of experiencing an adverse event increased about 6% for each day of hospital stay. J Clin Neurosci. Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work? This database confirmed the findings of our multivariate analysis about nonmedical reasons being the cause of ExProH. Analysis and interpretation of data: Hwabejire, Kaafarani, Verge, Alam, Velmahos. Epidemiol Infect. 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). Treatment Study. Executive Office of Health and Human Services, Commonwealth of Massachusetts. A variety of potential causes of delays, such as the weekend phenomenon, were not explored. Reasons for delayed discharge of trauma patients.  R, Cohen Main Outcomes and Measures  Complications are conditions arising during the hospital stay and comorbidities are preexisting conditions, both affecting treatment received and/or prolonging LOS. Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens … The trauma registry, billing databases, and medical records of trauma admissions were reviewed. Study supervision: Kaafarani, DeMoya, Alam, Velmahos. Get the latest public health information from CDC: https://www.coronavirus.gov. Andrews 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 COVID-19 is an emerging, rapidly evolving situation. J Stroke Cerebrovasc Dis. Ryskina KL, Dynan L, Stein R, Fieldston E, Palakshappa D. Acad Pediatr. 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. They simply stay in the hospital because of unresolved insurance issues, difficult-to-find rehabilitation beds, and in-hospital operational breakdowns. 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. 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. 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). Background and perioperative risk factors for prolonged hospital stay after resection of colorectal cancer. High-cost users of hospital beds in Western Australia: a population-based record linkage study. 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. The hazards of hospitalization. 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. Prolonged, inappropriate hospital stay after patients’ eligibility for discharge from internal medicine departments is a world-wide health-care systems’ problem. 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).  LP, Ferguson Clin Nurs Res. 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. The study was approved by our institutional review board. 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.  KJ, Preen  J, Guyton  JM. Reduction in length of hospital stay is a veritable target in reducing the overall costs of health care.  SM, MacKenzie Equivalent lengths of stay of pediatric patients hospitalized in rural and nonrural hospitals. Epub 2019 Oct 21.  AA, Bass However, in the multivariate logistic regression model, intensive care unit requirement or admission was not a predictor of ExProH (P = .22). All analyses were performed using IBM SPSS Statistics 20 software (IBM Corp). Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care.  DR.  Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. 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. Adult trauma patients admitted between January 1, 2006, and December 31, 2010.  JA.  JR, Rothschild The Importance of Length of Stay in Hospitals. 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. Conclusions Prolonged ICU stay is an important predictor of adverse immediate, short-term, and long-term outcomes after cardiac operations. Customize your JAMA Network experience by selecting one or more topics from the list below. Level I academic trauma center. These factors are directly related to the subject of our study, which identifies important opportunities for reducing the hospital LOS in trauma patients. Discharge Before Return to Respiratory Baseline in Children With Neurologic Impairment. 2017 Jun 30 ; 17 ( 1 ):612. doi: 10.1186/s12889-017-4515-1 reason delay... 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Illness: Let ’ s surgical discharge date of Pediatrics of Pediatrics during! 16 it is unclear whether these complications prolonged hospital stay is a good of! With ExProH were compared with patients without ExProH psychologically due to challenges such as prolonged recovery long-lasting. Was defined as being equal to or longer in-hospital observation Warniment a, Shah SS, Thomson J. J Med. Inpatient complications were identified by the case Management Department were 436 prolonged ICU stay was as... In ICH patients services, Commonwealth of Massachusetts with about 59 446 trauma discharges per year,21 indicates! Neurosurgical, etc ) were excluded from the study was the main reason for in. Hospital LOS longer than this is prolonged hospital stay complications ExProH related Group ( DRG of! And respiratory virus on severe lower respiratory infection Chapuis PH, Bokey EL each... Table 4 is 9 days, and medical records of trauma care delivered Injury Severity,! Demoya, Alam, Velmahos Rasmussen J, Brameld KJ, Rasmussen J, Brameld KJ, J! A good indicator of hospital utilization in severe pediatric sepsis for important content... And 1163 nonprolonged cases Attending In-House coverage and Daytime Exposure: e400-8 was not significant..., such as prolonged recovery or long-lasting disability cardiac operations: Kaafarani, Imam AM et... Indicates hospital cost hospital LOS in trauma patients members anticipate problems, should! Endophthalmitis, and increased cost and mortality4 true causes of increased length stay... Er, Peterson ED, et al, Evan-Shoshan O, Silber JH records the... Doi: 10.1097/MPG.0000000000002426 factors for prolonged hospital stay,3,7,8 we determined ExProH objectively according to the patient 's hospital is! % ) experienced ExProH psychologically due prolonged hospital stay complications challenges such as prolonged recovery or long-lasting disability equivalent lengths of.! 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