About 80% of the ExProH cases were not related to clinical issues and therefore could potentially be avoided (Table 5). The hazards of hospitalization. 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 Crossref Medline Google Scholar; 32. 1999; 8:336–343. Of 3237 patients, 155 (5%) had ExProH. The trim point is 9 days, and a hospital stay longer than this is considered ExProH. sign up for alerts, and more, to access your subscriptions, sign up for alerts, and more, to download free article PDFs, sign up for alerts, customize your interests, and more, to make a comment, download free article PDFs, sign up for alerts and more, Archives of Neurology & Psychiatry (1919-1959), http://www.ahrq.gov/research/findings/final-reports/efficiency/hcemch1.html, http://www.mass.gov/eohhs/gov/departments/dph/programs/health-stats/injury-suveillance/injury-data-facts-and-highlights.html, FDA Approval and Regulation of Pharmaceuticals, 1983-2018, Global Burden of Skin Diseases, 1990-2017, Health Care Spending in the US and Other High-Income Countries, Life Expectancy and Mortality Rates in the United States, 1959-2017, Medical Marketing in the United States, 1997-2016, Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter, US Burden of Cardiovascular Disease, 1990-2016, US Burden of Neurological Disease, 1990-2017, Waste in the US Health Care System: Estimated Costs and Potential for Savings, Register for email alerts with links to free full-text articles. Hospital stay beyond this period is considered ExProH. Definitions and DRG reporting requirements. In-hospital mortality was lower for ExProH patients. de Jong Administrative, technical, or material support: Verge, Sullivan, Velmahos. Published Online: August 21, 2013. doi:10.1001/jamasurg.2013.2148.  PS, Burst In this database, the case managers track potentially avoidable hospital days and the possible causes, including operational, payer-related, and clinical issues. Ryskina KL, Dynan L, Stein R, Fieldston E, Palakshappa D. Acad Pediatr. Conflict of Interest Disclosures: None reported. Steuart R, Tan R, Melink K, Chinchilla S, Warniment A, Shah SS, Thomson J. J Hosp Med.  JA. Despite these limitations, our study uncovers the true causes of ExProH. Excessively prolonged hospitalization and hospital cost. 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%. Table 1 compares the characteristics and clinical course of ExProH and non-ExProH patients. 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. Get free access to newly published articles. Data from the trauma registry were supplemented by information from the electronic medical records and the hospital’s billing records. Background and perioperative risk factors for prolonged hospital stay after resection of colorectal cancer. They simply stay in the hospital because of unresolved insurance issues, difficult-to-find rehabilitation beds, and in-hospital operational breakdowns. Establishing an ICD-10 code based SARI-surveillance in Germany - description of the system and first results from five recent influenza seasons. 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.  JD, Westert Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens … Although physicians should participate in all aspects of a patient’s care, there is little they can do to improve these specific issues. High-cost users of hospital beds in Western Australia: a population-based record linkage study. Factors associated with length of stay for pediatric asthma hospitalizations. We explored the utility of the UL-LOS indicator. 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. Cost-reduction efforts should target operational bottlenecks between acute and postacute care. 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). Patients with ExProH were compared with patients without ExProH. Hwabejire JO, Kaafarani HMA, Imam AM, et al. 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. Statistical significance was defined as P < .05. Of 3237 patients, 155 (5%) had ExProH. Additionally, these patients represent a significant economic problem on public health systems and their families. Forty-three percent of ExProH patients required intensive care unit admission compared with 32% of non-ExProH patients (P = .01). A prolonged ICU stay was defined as being equal to or longer than 10 days. Equivalent lengths of stay of pediatric patients hospitalized in rural and nonrural hospitals. 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. Interactive effects of age and respiratory virus on severe lower respiratory infection.  ER, Peterson  LP, Ferguson In-hospital operational delays were the reason for ExProH in 26%, and payer-related issues were the reason in 7%. 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. Other arbitrary cutoff points of prolonged hospital stay have been used in similar studies.3,8. Get the latest public health information from CDC: https://www.coronavirus.gov. 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. Massachusetts injury data facts and highlights. Study concept and design: Hwabejire, Kaafarani, Solis, Sullivan, DeMoya, Velmahos. Lack of rehabilitation or other subacute care facility bed was the main reason for delay in 83% of the 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.  LS, Chu Other studies have argued that comorbidities and complications prolong hospital stay. Calver Accessibility Statement, Table 1. Among ExProH patients, ExProH was caused by difficulties in transfer to a rehabilitation facility in 47%. 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.  ED, 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. 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. To identify the causes of excessively prolonged hospitalization (ExProH) in trauma patients. The specific discharge practices and hurdles of our region’s health care system may be less pertinent to other parts of the country. 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… Inpatient hospital complications and lengths of stay: a short report.  PA, DeLong 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.  SM, MacKenzie NLM 2013;148(10):956–961.  KA.  JR, Rothschild Lower respiratory infections in children. 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. Spratt N, Wang Y, Levi C, Ng K, Evans M, Fisher J. Trauma patients who stay for excessively prolonged periods in the hospital are not necessarily severely injured, physiologically compromised, or old. Of 3237 trauma patients admitted during the study period, 155 (5%) experienced ExProH. 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). Schimmel 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). The only independent predictors of ExProH were issues related to insurance coverage and discharge disposition. Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work? Patients with ExProH had a net margin lower than that of non-ExProH patients by nearly 50%.  RJ, Johnson The trauma registry, billing databases, and medical records of trauma admissions were reviewed. Design  Pediatrics. to download free article PDFs, 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. In the Commonwealth of Massachusetts with about 59 446 trauma discharges per year,21 this indicates hospital cost savings of approximately $130 000 000.  C, O'Dougherty Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care.  DR.  Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Results  Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. 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). We used χ2 or Fisher exact tests for comparisons between categorical variables. Long Stay Patients Long stays are NOT always inappropriate but prolonged hospitalisation is associated with significant social, economic, physical and psychological burden. 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. The generalization of these findings to other facilities is unknown.  C, Weigelt Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 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. septic arthritis, endophthalmitis, and meningitis in patients. All Rights Reserved. Patel PV, Pantell MS, Heyman MB, Verstraete S. J Pediatr Gastroenterol Nutr. 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. The causes of ExProH were explored in a unique potentially avoidable days database, used by our hospital’s case managers to track discharge delays. Diagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure. Summary statistics were used to describe continuous variables, while proportions were calculated for categorical variables. Clinical reasons included delays in discharge because of changes in the patient’s clinical condition that required further tests or longer in-hospital observation. 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. The causes of ExProH were explored in a unique potentially avoidable days database, used by our hospital’s case managers to track discharge delays.  G, Morin 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. Discharge Before Return to Respiratory Baseline in Children With Neurologic Impairment. NIH We expect this information to be interesting to policy makers who are striving to understand the medical system and its associated cost. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon’s National Cardiac Database. A variety of potential causes of delays, such as the weekend phenomenon, were not explored. A strength of our study was the definition of ExProH. 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. Terms of Use| 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).  et al; IHD Port Investigators. Epub 2013 May 15. However, in the multivariate logistic regression model, intensive care unit requirement or admission was not a predictor of ExProH (P = .22). Compared with the PLOS model, the PPOLOS model better predicted risk of prolonged hospital stay. We used multivariable logistic regression models to identify factors associated with prolonged LOS (>90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death). Irshad  PA, DeLong This means that ExProH could be reduced from 5% to 1%. Allman  N, Bartolucci Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care.  LB, Stocking Privacy Policy| Critical revision of the manuscript for important intellectual content: Hwabejire, Solis, Verge, Sullivan, DeMoya, Alam, Velmahos. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. An alternative strategy for studying adverse events in medical care.  GP, Lagoe 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. The remaining discharges were excessively delayed because of difficulties in rehabilitation facility placement (47%), in-hospital operational delays (26%), or payer-related issues (7%). 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). 2015 Jun;52(5):471-7. doi: 10.3109/02770903.2014.984843. "Far and away, the most serious hospital risk is a medication error," says Carolyn … Andrews  MP.  EL. This database confirmed the findings of our multivariate analysis about nonmedical reasons being the cause of ExProH. Epub 2019 Oct 21. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. An additional strength was the analysis of the potentially avoidable hospital days database, which is populated prospectively by our case managers. 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. Medical complications of ischemic stroke and length of hospital stay: experience in Seattle, Washington. 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. 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. Epub 2018 Jul 26. 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. And the average hospital stay for an elderly person is $12,000, according to the Agency for Healthcare Research and Quality.  ER, Peterson © 2020 American Medical Association. Study supervision: Kaafarani, DeMoya, Alam, Velmahos.  et al. Morris All Rights Reserved. Cowper Complications are conditions arising during the hospital stay and comorbidities are preexisting conditions, both affecting treatment received and/or prolonging LOS. Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. Conclusions: This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Based on the ExProH reasons identified, we believe that LOS and cost can be reduced without compromising the quality of trauma care delivered. Geographic variation in resource use for coronary artery bypass surgery. Type of study. For this, we used a unique database maintained by the Case Management Department. Adult trauma patients admitted between January 1, 2006, and December 31, 2010.  RM, Goode J Clin Neurosci. ... KHN’s coverage of aging and long-term care issues is …  VF, Dorval 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). Prasad N, Trenholme AA, Huang QS, Thompson MG, Pierse N, Widdowson MA, Wood T, Seeds R, Taylor S, Grant CC, Newbern EC; SHIVERS team. Reduction in length of hospital stay is a veritable target in reducing the overall costs of health care. Conclusions and Relevance   R, Cohen  ED, Health care efficiency measures: identification, categorization, and evaluation.  DW, Franz There is little doubt that the patient’s physiological condition and the postoperative morbidity play a crucial role in the duration of hospital stay.  TB, If the person or family members anticipate problems, they should discuss preventive measures with staff members.  ED, Coombs  PP.  |  Level I academic trauma center. This difference was not statistically significant (P = .10). The risk of physical harm runs through even the safest … Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study. 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). Additionally, these patients represent a significant economic problem on public health systems and their families. These factors are directly related to the subject of our study, which identifies important opportunities for reducing the hospital LOS in trauma patients. The financial burden of such unnecessary hospitalization is heavy.  JC, Cashin 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. 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.  EL, Craver  KJ, Preen Kramer COVID-19 is an emerging, rapidly evolving situation. All analyses were performed using IBM SPSS Statistics 20 software (IBM Corp).  et al. 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.  C.  Determinants of prolonged length of hospital stay after coronary bypass surgery.  KJ, Rasmussen Objective Surgical complications may affect patients psychologically due to challenges such as prolonged recovery or long-lasting disability.

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