Admission variables predicting short lengths of stay of acutely unwell older patients: relevance to emergency and medical short-stay units

Abstract

Objective: To help develop criteria to identify older patients suitable for admission to medical short-stay units, by determining predictors of length of stay (LOS) of 3 days or less. Methods: The data were prospectively collected from consecutive older patients admitted from the emergency department of a university hospital to an acute geriatric medicine service. Data included active medical diagnoses, the Modified Barthel Index (MBI), the Timed Up and Go (TUG) test, and demographic information. Logistic regression was used to model the probability of LOS of 3 days or less (short LOS). Results: Among 2036 patients discharged alive from hospital (mean age, 82 years; median LOS, 7 days), 398 had a short LOS (median, 2 days), while 1638 had a long LOS (median, 9 days). In logistic regression analysis, the main independent predictors of short LOS were an MBI score > 15/20 (OR, 2.98; 95% CI, 1.97-4.49), ability to perform the TUG test (OR, 2.08; 95% CI, 1.34-3.24) and absence of delirium (OR, 2.66; 95% CI, 1.56-4.54). Patients without infection, anaemia, gastrointestinal disorder and stroke were also more likely to have a short LOS in multivariate analysis (all P < 0.05). Conclusion: Preserved function, measured using the MBI and TUG, and the absence of delirium are strong predictors of short LOS. In conjunction with early, skilled clinical evaluation, these criteria could be used to select older patients presenting to the emergency depart- ments for admission to short-stay units.THE INCREASING NUMBER and proportion of older persons is having profound consequences and far-reaching implications, especially for health care systems. Older persons visit the emergency department and are admitted to hospital in greater numbers than their proportion in the total population.1 Due to escalating demands on a limited health workforce and budget, pressures on emergency departments and hospitals are growing, 2 leading to increasing scrutiny and evaluation of systems of care.

Diagnostic pathways of the complex patients: rapid intensive observation in an Acute Medical Unit

“…Doctors and nurses become gradually more and more responsible in their decision making and conscious of the relevance of the project. As reported elsewhere [26], a preserved function and a lower number of previous admissions were factors significantly associated to a short stay.…”

“…From this analysis it also emerges that on average 70% of patients presenting to the ED with acute medical illness will be eligible for admission to AMU and that between 20 to 50% of these patients will be dischargeable within 48 h. Recent investigations have identified several factors predicting a hospital stay up to 3 days among older patients, such as preserved function (measured using the modified Barthel Index), absence of delirium, as well as of infection, anaemia, gastrointestinal disorders and stroke. These individuals are more likely to have a short length of stay and therefore more suitable for admission to the AMU [26].…”

Scoping review of medical assessment units and older people with complex health needs

“…For example, exclusion of non‐English literature and studies describing services such as observation or short stay units that operate similarly to MAUs that did not comply with the IMSANZ standards. Some of these articles included topics relevant to the two main foci of this review (older people and MAUs) such as techniques in risk assessment, nursing models of care, diagnostic pathways for complex patients, cognitive screening for older people and the use of funnel plots to improve efficiency and reduce patient mortality .…”

Epidemiology of long‐stay patients in a university teaching hospital

“…Such studies have generated a very broad list of factors that may be associated with prolonged hospital length of stay (LOS) (Appendix I) . To our knowledge, there has been no study examining the epidemiology of a diverse cohort of hospitalised patients and the implication of such patients with regards to overall hospital bed utilisation and occupancy.…”