Justification of Hospital Days and Epidemiology of Discharge Delays in a Department of Neurology

Schluep, Myriam; Bogousslavsky, Julien; Régli, F; Tendon, M.; Prod’hom, L. S.; Kleiber, Charmaine

doi:10.1159/000110357

Cited by 15 publications

(9 citation statements)

References 4 publications

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“…[8][9][10][11][12][13][14] Furthermore, patterns in the ordering of medical tests and factors that determine the use of investigations have also been described in countries outside 15 This amounts to a 2.5% increase overall, but the figure for general internal medicine (including elderly care medicine) was 6.6%. This is of concern since inpatient beds are a costly resource, which is ever more precious as demands on the NHS grow through an increasing number of annual hospital admissions.…”

Section: Discussionmentioning

confidence: 99%

“…15 Identified factors predicting prolonged LOS in other countries include specialty of attending physician, nosocomial infection, and delay in obtaining laboratory or radiological examination results. [8][9][10][11][12] Among the elderly, diagnoses of fall, dementia, fracture, neoplasm, bronchitis, arterial disease, and hyponatraemia are known to be associated with longer LOS. 13 14 The single most useful patient characteristic for predicting LOS, in our data, was patient age; presumably this reflects a greater need for pre-discharge social care planning in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

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Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission

McMullan

Silke

Bennett

et al. 2004

Postgraduate Medical Journal

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Objectives: To describe the patient demographic characteristics and organisational factors that influence length of stay (LOS) among emergency medical admissions. Also, to describe differences in investigation practice among consultant physicians and to examine the impact of these on LOS. Design: Prospective observational study. Setting: General medicine department of a teaching hospital in Belfast, UK. Participants: Data were recorded for patients who were admitted as emergencies and reviewed on the post-take ward rounds (PTWR) attended by the investigation coordinator. Outcome measures: Non-laboratory investigations requested, LOS, and diagnosis on discharge. Results: Of 830 episodes evaluated, the median LOS was 7 days (interquartile range 3-12 days); this was significantly longer for admissions on Fridays (p = 0.0011) and for patients managed on medical wards (p,0.0001). There was a positive correlation between patient age and LOS (r = 0.32, p,0.0001). Chest radiographs (p = 0.002) and echocardiography (p = 0.015) were associated with a prolonged LOS; no investigations were associated with a shortened LOS. Diagnoses of congestive heart failure, respiratory disease, and cancer were associated with a longer LOS; a diagnosis of angina was associated with a shorter LOS. Considerable variation in investigation ordering, but no difference in LOS, was observed between consultants. High use of a given medical test did not correlate with high use of other tests. Conclusion: A systematic means of dealing with the NHS resource crisis should include an improved organisational strategy as well as social care provision. A more unified approach to investigation practice should also have a sparing effect on resources. W hile several investigators have previously reported factors responsible for the increasing use of medical investigations in various settings, [1][2][3][4][5][6][7] as well as factors contributing to prolonged hospital inpatient episodes, there are few data describing the demographic characteristics, patterns of investigation, and length of stay (LOS) of patients admitted as emergencies to general medicine units in the UK. The principal objective of this study is to report these characteristics in a general medical department of a teaching hospital in Belfast, Northern Ireland. Furthermore, we aim to describe variations in the ordering of medical tests between general physicians and to identify correlations between the ordering of specific investigations and LOS. Moreover, we wished to determine, first, whether high use of a specific diagnostic procedure correlated with high use of other diagnostic procedures and, second, whether high use of such investigations influenced LOS. PATIENTS AND METHODS Data relating to emergency medical patients admitted toBelfast City Hospital between 1 June 2000 and 31 December 2000 were recorded. Belfast City Hospital, although a tertiary referral centre for various specialties, operates an alternate day acute general medical take-in serving as a secondary care centre for emerg...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission

McMullan

Silke

Bennett

et al. 2004

Postgraduate Medical Journal

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“…In one UK study, it was revealed that 88% of adult patients with a delayed discharge had a primary neurological diagnosis [ 18 ]. Awaiting provision of social care, home adaptations and transfer to another care facility are all associated with an inappropriate LoS amongst this patient population [ 18 , 23 - 25 ]. Similarly, a study of patients with brain injury revealed that failure to find a suitable placement and failure to obtain funding for post discharge support were common causes of delayed discharges [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions

Hammond

Phillips

Pinnington

et al. 2009

BMC Health Serv Res

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BackgroundTo examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs). To identify variables predictive of appropriateness and explore management alternatives.MethodsAdults admitted as acute patients to Derby Hospitals NHS Foundation Trust (England). Data were collected prospectively and examined by a multi-disciplinary expert panel to determine the appropriateness of admission and length of stay (LoS). Management alternatives were discussed.ResultsA total of 119 participants were recruited. 32 admissions were inappropriate and 83 were for an inappropriate duration. Whether a participant lived in their own home was predictive of an inappropriate admission. The number of LTNCs, number of presenting complaints and whether the participant lived alone in their own home were predictive of an inappropriate LoS. For admissions judged to be inappropriate, the panel suggested management alternatives.ConclusionPatients with LTNCs are being admitted to hospital when other services, e.g. ambulatory care, are available which could meet their needs. Inefficiencies in hospital procedures, such as discharge planning and patient transfers, continue to exist. Recognition of the need to plan for discharge at admission and to ensure in-patient services are provided in a timely manner may contribute towards improved efficiency.

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“…Most delays among hospitalized patients stem from scheduling of diagnostic test procedures [1,2]. The types of events that delay patient management relate to a large variety of medical, organizational, administrative and technical obstacles that often render a timely and expeditious management difficult.…”

Section: Introductionmentioning

confidence: 99%

Scheduling Medical Procedures: How One Single Delay Begets Multiple Subsequent Delays

Sonnenberg

Crain

2005

Computational and Mathematical Methods in Medicine

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Background: Delay is a common feature of medical disease management. Delays occur because schedules are filled, patients forget their appointment, equipment is unavailable, or because medical and non-medical complications interfere with the planned procedure. The aim of the present analysis is to model how one single delay can lead to multiple subsequent delays. Methods: The consecutive stream of delays is analyzed in terms of a stochastic process comprising of a random sum of random time periods. Any untoward event causes a procedural delay, which provides a time window of opportunity for yet another delaying event to occur. Results: The stochastic model explains why even a single initial delay can easily lead to a multitude of subsequent delays. The expected overall delay is always longer than the initial delay caused by the deferment of the initial procedure. The analysis demonstrates how in individual patients an initially short delay may subsequently expand into days or weeks. Conclusion: Because a single delay can easily burgeon into a lengthy series of multiple delays, the primary goal should be to avoid the precipitating delay at the onset.

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Justification of Hospital Days and Epidemiology of Discharge Delays in a Department of Neurology

Cited by 15 publications

References 4 publications

Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission

Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission

Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions

Scheduling Medical Procedures: How One Single Delay Begets Multiple Subsequent Delays

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