Factors associated with delays in discharge for trauma patients at an urban county hospital

Cai, Christopher; Lindquist, Karla; Bongiovanni, Tasce

doi:10.1136/tsaco-2020-000535

Cited by 9 publications

(22 citation statements)

References 22 publications

(22 reference statements)

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“…The distribution of payers was Medicaid (54.6%), Medicare (24.0%), and commercial (21.4%). The median hospital stay was 4 days 2–7 . There were 69.2% of patients admitted to the ICU with a median ICU stay of 3 days 2–6 .…”

Section: Resultsmentioning

confidence: 99%

“…[2][3][4][5][6][7] There were 69.2% of patients admitted to the ICU with a median ICU stay of 3 days. [2][3][4][5][6] The contribution margin was positive in 41.2% (n = 1008) of the cases. The median contribution margin was −$2890 with interquartile range from −$10872 to $7084.…”

Section: Resultsmentioning

confidence: 99%

“…Enhanced focus on length of stay for government-insured patients, then, may not yield significant cost savings. In addition, there is an array of factors that have an effect on a patient's length of stay that influence discharge management including discharge disposition (home vs. long-term care), patient and family input into the specific discharge destination, and safe housing 4 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is an array of factors that have an effect on a patient's length of stay that influence discharge management including discharge disposition (home vs. long-term care), patient and family input into the specific discharge destination, and safe housing. 4 An alternative approach might be to focus on improvement in clinical documentation. Our modeling demonstrated that contribution margin correlated positively with DRG weights among all patients irrespective of payer source.…”

Section: Discussionmentioning

confidence: 99%

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Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center

Chavez

Bogert²,

Soe-Lin³

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:In an effort to reduce costs, hospitals focus efforts on reducing length of stay (LOS) and often benchmark LOS against the geometric LOS (GMLOS) as predicted by the assigned diagnosis-related group (DRG) used by the Centers for Medicare and Medicaid Services. The objective of this cross-sectional study was to evaluate the impact of exceeding GMLOS on hospital profit/loss with respect to payer source. METHODS:Contribution margin for each insured patient admitted to a Level I trauma center between July 1, 2016, and June 30, 2019, was determined. Age, ethnicity, race, DRG weight, DRG version, injury severity, intensive care unit admission status, mechanical ventilation, payer, exceeding GMLOS, and the interaction between payer and exceeding the GMLOS were regressed on contribution margin to determine significant predictors of positive contribution margin. RESULTS:Among 2,449 insured trauma patients, the distribution of payers was Medicaid (54.6%), Medicare (24.0%), and commercial (21.4%). Thirty-five percent (n = 867) of patient LOS exceeded GMLOS. Exceeding GMLOS by 10 or more days was significantly more likely for Medicaid and Medicare patients in stepwise fashion (commercial, 2.7%; Medicaid, 4.5%; Medicare, 6.0%; p = 0.030). Median contribution margin was positive for commercially insured patients ($16,913) and negative for Medicaid (−$8,979) and Medicare (−$2,145) patients. Adjusted multivariate modeling demonstrated that when exceeding GMLOS, Medicare and Medicaid cases were less likely than commercial payers to have a positive contribution margin ( p < 0.001 and p < 0.001). CONCLUSION:Government-insured patients, despite having a payer source, are a financial burden to a trauma center. Excess LOS among government insured patients, but not the commercially insured, exacerbates financial loss. A shift toward a greater proportion of government insured patients may result in a significant fiscal liability for a trauma center. (

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center

Chavez

Bogert²,

Soe-Lin³

et al. 2022

J Trauma Acute Care Surg

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“…1 Furthermore, greater than 40% of delayed discharges are placement-related, including awaiting placement at skilled nursing facilities (SNFs) and long-term acute care hospitals (LTACs). [1][2][3][4] Geriatric trauma patients (GTPs) represent a continuously growing percentage of the trauma population, comprising 31% of trauma incidents in 2016, and often require SNFs/LTACs due to a combination of traumatic injuries and baseline functional health. 5 Consequently, the throughput of GTPs could potentially improve with advanced anticipation of these needs.…”

Section: Introductionmentioning

confidence: 99%

The DEPARTS Score: A Novel Tool for Predicting Discharge Disposition in Geriatric Trauma Patients

Yeates

Grigorian

Kuza

et al. 2021

The American Surgeon

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Background Geriatric trauma patients (GTPs) represent a high-risk population for needing post-acute care, such as skilled nursing facilities (SNFs) and long-term acute care hospitals (LTACs), due to a combination of traumatic injuries and baseline functional health. As there is currently no well-established tool for predicting these needs, we aimed to create a scoring tool that predicts disposition to SNFs/LTACs in GTPs. Methods The adult 2017 Trauma Quality Improvement Program database was divided at random into two equal sized sets (derivation and validation sets) of GTPs >65 years old. First, multiple logistic regression models were created to determine risk factors for discharge to a SNF/LTAC in admitted GTPs. Second, the weighted average and relative impact of each independent predictor was used to derive a DEPARTS ( Discharge of Elderly Patients After Recent Trauma to SNF/LTAC) score. We then validated the score using the area under the receiver-operating curve (AROC). Results Of 66 479 patients in the derivation set, 36 944 (55.6%) were discharged to a SNF/LTAC. Number of comorbidities, fall mechanism, spinal cord injury, long bone fracture, and major surgery were each independent predictors for discharge to SNF/LTAC, and a DEPARTS score was derived with scores ranging from 0 to 19. The AROC for this was .74. In the validation set, 66 477 patients also had a SNF/LTAC discharge rate of 55.7%, and the AROC was .74. Discussion The DEPARTS score is a good predictor of SNF/LTAC discharge for GTPs. Future prospective studies are warranted to validate its accuracy and clinical utility in preventing delays in discharge.

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Characterizing patients hospitalized without an acute care indication: A retrospective cohort study

Rosenthal

Ranji

Kanzaria

et al. 2023

Journal of Hospital Medicine

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Background: Hospitalizations by patients who do not meet acute inpatient criteria are common and overburden healthcare systems. Studies have characterized these alternate levels of care (ALC) but have not delineated prolonged (pALC) versus short ALC (sALC) stays.Objective: To descriptively compare pALC and sALC hospitalizations-groups we hypothesize have unique needs.Designs, Settings, and Participants: A retrospective study of hospitalizations from March-April 2018 at an academic safety-net hospital.Main Outcome and Measures: Levels of care for pALC (>3 days) and sALC (1-3 days) were determined using InterQual©, an industry standard utilization review tool for determining the clinical appropriateness of hospitalization.We examined sociodemographic and clinical characteristics.Results: Of 2365 hospitalizations, 215 (9.1%) were pALC, 277 (11.7%) were sALC, and 1873 (79.2%) had no ALC days. There were 17,683 hospital days included, and 28.3% (n = 5006) were considered ALC. Compared to patients with sALC, those with pALC were older and more likely to be publicly insured, experience homelessness, and have substance use or psychiatric comorbidities.Patients with pALC were more likely to be admitted for care meeting inpatient criteria (89.3% vs. 66.8%, p < .001), had significantly more ALC days (median 8 vs. 1 day, p < .001), and were less likely to be discharged to the community (p < .001).Conclusions: Patients with prolonged ALC stays were more likely to be admitted for acute care, had greater psychosocial complexity, significantly longer lengths of stay, and unique discharge needs. Given the complexity and needs for hospitalizations with pALC days, intensive interdisciplinary coordination and resource mobilization are necessary.

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Factors associated with delays in discharge for trauma patients at an urban county hospital

Cited by 9 publications

References 22 publications

Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center

Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center

The DEPARTS Score: A Novel Tool for Predicting Discharge Disposition in Geriatric Trauma Patients

Characterizing patients hospitalized without an acute care indication: A retrospective cohort study

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