Factors associated with prolonged length of stay in older patients

Toh, Hui Jin; Lim, Zhen Yu; Yap, Philip; Tang, Terence

doi:10.11622/smedj.2016158

Cited by 81 publications

(74 citation statements)

References 32 publications

(32 reference statements)

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“…The association between increased patient age and longer transportation time or increased number of EMS negotiations until acceptance reflects the complexities and resource-intensive characteristics of geriatric medicine and the unwillingness on the part of hospitals to take on this burden 15,16) . In contrast, NAEDs are capable of handling geriatric emergency problems, in conjunction with a general internal medicine team.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Longer Transportation Time to North American Style Emergency Department in Japan

Shiga

Taira

Taira³

et al. 2019

J St. Marianna Univ

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Japanese emergency departments have traditionally been separated into tertiary and secondary centers. Tertiary emergency centers focus on the care of trauma and critically ill patients, while secondary emergency centers operate with limited resources and only accept patients of a limited acuity from emergency medical services (EMS). In contrast, North American-style Emergency Departments (NAED) have been developed, with the aim of accepting both critical and non-critical patients. We conducted a retrospective, observational study using municipal EMS records from 2012 in a Japanese city. Our aim was to identify patient characteristics associated with long EMS transportation times to NAED in an urban city where both traditional and NAED centers are available. The primary endpoint was long transportation time, defined as >35 minutes. Other items included the distance of transportation from the scene (km), age, sex, reason for transportation (medical or surgical), relevant specialty determined by EMS, condition severity, number of EMS negotiations until acceptance, and the reason for diversion by other hospitals. Multivariate logistic regression was used to find characteristics associated with long transportation time. A total of 2934 patients were included in the analysis. Median transportation time was 29 minutes . Characteristics that were associated with long transportation time included age (years) (OR, 1.02; 95%CI, 1.02-1.03; P<0.01), patients with orthopedic (OR, 1.69; 95%CI, 1.08-2.66; P=0.02) or neurosurgical (OR, 1.72; 95%CI, 1.21-2.47; P<0.01) conditions, and the number of EMS negotiations until acceptance (OR, 4.08; 95%CI, 3.12-5.33; P<0.01). Long transportation times were negatively associated with patients with medical (OR, 0.66; 95%CI, 0.46-0.96; P=0.03) and ear nose and throat (ENT) (OR, 0.13; 95%CI, 0.04-0.44; P<0.01) conditions. This is likely because the NAEDs fill an unmet need for patients that require certain types of care, such as surgical or neurosurgical treatment, or because they accept patients that have been refused by other centers.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Longer Transportation Time to North American Style Emergency Department in Japan

Shiga

Taira

Taira³

et al. 2019

J St. Marianna Univ

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“…The duration of hospitalization may re ect the severity of diseases, complications rates, and medical costs. Furthermore, studies in geriatric and general populations indicate that prolonged hospitalization is associated with increased functional dependence, infection, and comorbidities [18][19][20].…”

Section: Spot Sign Surgery and Length Of Hospital Staymentioning

confidence: 99%

Early Spot Sign is Associated with Functional Outcomes in Primary Intracerebral Hemorrhage Survivors

Hsiao

Tseng

Wang

et al. 2020

Preprint

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Background The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and 30-day mortality in intracerebral hemorrhage (ICH). However, whether the spot sign predicts worse functional outcomes among ICH survivors remains unclear. This study investigated the frequency of the spot sign and its association with functional outcomes and length of hospital stay among ICH survivors.Methods This was a retrospective analysis of consecutive patients with primary ICH who received CTA within 24 h from presentation to admission to the emergency department of a single medical center between January 2007 and December 2017. Patients who died before discharge and those referred from other hospitals were excluded. CTAs with motion artifacts were excluded from the analysis. The presence of a spot sign was examined by an experienced neuroradiologist. Functional outcomes were determined based on the modified Rankin Scale (mRS) score and Barthel Index (BI). Severe dependency in activities of daily living (ADL) was defined as BI of ≤60 and severe disability as an mRS score of ≥4. Odds ratio (OR) and multiple linear regression were used as measures of association.Results In total, 66 patients met the inclusion criteria, of whom 9 (13.64%) were positive for a spot sign. No significant differences were observed in baseline characteristics between patients with and without a spot sign. Patients with a spot sign tended to be severely dependent in ADL at discharge (66.67% vs 41.07%; OR = 2.87; p = 0.15) and were more likely to require ICH-related surgery (66.67% vs 24.56%; OR = 6.14; p = 0.01). In multiple linear regression, patients with a higher spot sign score had a significantly longer hospital stay (coefficient = 9.57; 95% CI = 2.11–17.03; p = 0.013).Conclusions The presence of a spot sign is a common finding and is associated with longer hospital stay and possibly worse functional outcomes in ICH survivors.

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“…Along with a rapid growing number of older adults, the vulnerability in their health care, such as comorbid health conditions, chronic disease, and medical complications, increases the financial burden on the healthcare system, including length of stay in hospitalization (Arboix et al, ; Toh, Lim, Yap, & Tang, ). There is inconclusive evidence on healthcare costs and quality of care.…”

Section: Introductionmentioning

confidence: 99%

“…Bo et al (2016) also found that longer length of inpatient stay was associated with cognitive impairment, functional dependence, and higher comorbidity burden. A recent study by Toh et al (2017) found that severity of illness and functional impairment status were likely to increase length of inpatient stays. On the other hand, Ellison and Bauchner (2007) postulated that an individual's socioeconomic status had no clinical effect on length of inpatient stays among children with vaso-occlusive crises in sickle cell disease (Ellison & Bauchner, 2007).…”

mentioning

confidence: 99%

Length of inpatient stays and associated factors among middle‐aged and older adults in Korea

Lee

2019

Asian Soc Wrk & Pol Rev

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Using a nationally representative sample of middle‐aged and older adults in Korea, this study examined the length of inpatient stays and associated factors. The pooled 2008–2012 data were obtained from the Korean Longitudinal Study of Aging, and study sample consisted of 7,805 individuals aged 50 and older. Guided by the Andersen's healthcare utilization model, latent growth curve modeling was conducted. Study results indicate that the average inpatient stay has slightly increased among middle‐aged and older adults in Korea. Furthermore, the severity of functional disability, the number of chronic health conditions, and the level of depressive symptoms were found to be key factors associated with the length of inpatient stays. In particular, respondents who received federal welfare benefits had longer stays than those who did not receive welfare benefits. Being employed and having private insurance were also found to be predictors of increasing length of inpatient stays. However, marital status was not associated with the length of inpatient stays. By understanding the pattern of inpatient stays and associated factors, policymakers should make an effort to develop innovative cost‐effective healthcare programs.

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Factors associated with prolonged length of stay in older patients

Cited by 81 publications

References 32 publications

Factors Associated with Longer Transportation Time to North American Style Emergency Department in Japan

Factors Associated with Longer Transportation Time to North American Style Emergency Department in Japan

Early Spot Sign is Associated with Functional Outcomes in Primary Intracerebral Hemorrhage Survivors

Length of inpatient stays and associated factors among middle‐aged and older adults in Korea

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