Interventions to Reduce Hospital Length of Stay in High-risk Populations

Siddique, Shazia Mehmood; Tipton, Kelley; Leas, Brian F; Greysen, S. Ryan; Mull, Nikhil K.; Lane‐Fall, Meghan; McShea, Kristina; Tsou, Amy Y.

doi:10.1001/jamanetworkopen.2021.25846

Cited by 95 publications

(87 citation statements)

References 56 publications

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“…32,33 In term of patients' related factors, previous studies have shown that old age, patient with multiple comorbidities including chronic heart failure, stroke, and soft tissue infection at increased risk of prolonged length of hospital stay. 34,35 Our study has shown that the majority of patients were hospitalized with circulatory and respiratory systems diseases. Pneumonia and exacerbations of chronic lung disease were among the most common diagnoses, with a median length of hospital stay of 6 days, which is higher than the reported length of hospital stay in similar health settings (i.e.…”

Section: Discussionmentioning

confidence: 95%

“…5,9,41,42 Also, geriatric assessment for old patients, implementing of clinical pathways for management of common diagnoses such as heart failure, medications for patients with polypharmacy, and case management may reduce length of hospital stay. 34,43 This study has many strengths. It is one of the few studies from the Middle East Region where the expanding population puts extreme pressure on health care systems.…”

Section: Discussionmentioning

confidence: 99%

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Inappropriate Hospital Stay of Patients Admitted Under Care of General Medicine Units

Al-Yarabi

Balushi²,

Hatmi³

et al. 2022

Sultan Qaboos Univ Med J

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Objective: This study aims to assess the incidence of inappropriate hospital stay and to identify reasons behind inappropriate hospitalisation. Methods: The study was a retrospective cohort study included patients admitted under the care of General Internal Medicine. First, we calculated the average length of hospital stay for all included patients, and then we used Appropriateness Evaluation Protocol to examine admissions that exceeded the average length of hospital stay and then identify reasons for the inappropriate hospital stay. Results: There were 854 admissions during the study period. In this cohort, 53.1% were men, and the median age was 64 (IQR:44-75) years. There was a total of 6785.4 hospitalization days, and the average length of hospital stay was 5 (IQR:3-9) days. 31.9% of admissions (n=272 admissions) included inappropriate hospitalization days. 9.9 % (n=674 days) of hospitalization days were classified as inappropriate. Delay in complementary tests (29.0%), and unavailability of extra-hospital resources (21.7%) were the most common reasons associated with inappropriate hospital stay. Old Age was associated with increased inappropriate hospital stay. Conclusion: A significant proportion of hospitalisation days were inappropriate due to hospital related factors. Therefore, auditing hospital services, and investing in home-based care are among the top strategies which are likely to improve early discharge and minimize inappropriate hospital bed occupancy. Keywords: Hospital Stay; Hospitalization, patient discharge; General Internal Medicine

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Inappropriate Hospital Stay of Patients Admitted Under Care of General Medicine Units

Al-Yarabi

Balushi²,

Hatmi³

et al. 2022

Sultan Qaboos Univ Med J

View full text Add to dashboard Cite

show abstract

“…This is important, as many previous improvement studies were limited by complex interventions or cumbersome implementations, and it has been suggested that team-based care approaches would have limited success. 19,[28][29][30] Given the clinical setting with a heterogeneous patient population, this nationwide large-scale study, showing high tool use and systematic assessment of outcomes with no missing data, may fill an important gap in the current evidence about the effectiveness of interprofessional-led discharge planning to reduce LOS.…”

Section: Discussionmentioning

confidence: 99%

Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity

et al. 2022

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ImportanceWhether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial.ObjectiveTo evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity.Design, Setting, and ParticipantsThis multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022.InterventionAfter a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning.Main Outcomes and MeasuresMixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals.ResultsThere were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by −0.344 hr/mo (95% CI, −0.599 to −0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (−0.034 hr/mo; 95% CI, −0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, −0.011 hr/mo; 95% CI, −0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by −0.879 hr/mo (95% CI, −1.607 to −0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time.Conclusions and RelevanceIn this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge.Trial Registrationisrctn.org Identifier: ISRCTN83274049

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“…Studies have examined LOS predictors to inform intervention and targeting strategies [4,5,[7][8][9]. A recent systematic review found that for patients with medically complex conditions, discharge planning, medication management, and interdisciplinary care teams were associated with inconsistent outcomes (LOS, readmissions, mortality) across populations [31]. There are no systematic reviews studying interventions for patients with socioeconomic risk; 70% of our admissions derive from a high deprivation inner-city population [32].…”

Section: Discussionmentioning

confidence: 99%

Hospital mortality and length of stay differences in emergency medical admissions related to ‘on-call’ specialty

et al. 2022

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Background The outcomes of acute medical admissions have been shown to be influenced by a variety of factors including system, patient, societal, and physician-specific differences. Aim To evaluate the influence of on-call specialty on outcomes in acute medical admissions. Methods All acute medical admissions to our institution from 2015 to 2020 were evaluated. Admissions were grouped based on admitting specialty. Thirty-day in-hospital mortality and length of stay (LOS) were evaluated. Data was analysed using multivariable logistic regression and truncated Poisson regression modelling. Results There were 50,347 admissions in 30,228 patients. The majority of admissions were under Acute Medicine (47.0%), and major medical subspecialties (36.1%); Elderly Care admitted 12.1%. Acute Medicine admissions were older at 72.9 years (IQR 57.0, 82.9) vs. 67.2 years (IQR 50.1, 80.2), had higher Acute Illness Severity (grades 4–6: 85.9% vs. 81.3%; p < 0.001), Charlson Index (> group 0; 61.5% vs. 54.6%; p < 0.001), and Comorbidity Score (40.7% vs. 36.7%; p < 0.001). Over time, there was a small (+ 8%) but significant increase in 30-day in-hospital mortality. Mortality rates for Acute Medicine, major medical specialties, and Elderly Care were not different at 5.1% (95% CI: 4.7, 5.5), 4.7% (95% CI: 4.3, 5.1), and 4.7% (95% CI: 3.9, 5.4), respectively. Elderly Care admissions had shorter LOS (7.8 days (95% CI: 7.6, 8.0)) compared with either Acute Medicine (8.7 days (95% CI: 8.6, 8.8)) or major medical specialties (8.7 days (95% CI: 8.6, 8.9)). Conclusion No difference in mortality and minor differences in LOS were observed. The prior pattern of improved outcomes year on year for emergency medical admissions appears ended.

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Interventions to Reduce Hospital Length of Stay in High-risk Populations

Cited by 95 publications

References 56 publications

Inappropriate Hospital Stay of Patients Admitted Under Care of General Medicine Units

Inappropriate Hospital Stay of Patients Admitted Under Care of General Medicine Units

Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity

Hospital mortality and length of stay differences in emergency medical admissions related to ‘on-call’ specialty

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