Predictive model of length of stay in hospital among older patients

Lisk, Radcliffe; Uddin, Mahir; Parbhoo, Anita; Yeong, Keefai; Fluck, David; Sharma, Pankaj; Lean, Michael E. J.; Han, Thang S.

doi:10.1007/s40520-018-1033-7

Cited by 43 publications

(42 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The association between NHFS and prolonged LOS in hospital observed in our study mirrors those reported by Moppett et al [11] who showed increasing NHFS was related inversely to the proportions of patients being discharged early back to their own home. The extra days spent in hospital by patients with NHFS in the intermediate (2 days) or in the high risk (4 days) groups are similar to those observed in patients admitted with cognitive impairment or delirium [4]. Our observations of the association between high NHFS with discharge to residential/nursing care are also consistent with the findings of a negative correlation between NHFS and eventual return-to-home by Moppett et al [11].…”

Section: Discussionsupporting

confidence: 89%

“…Through our participation in the National Hip Fracture Database (NHFD) Audit Programme [4,12,13], data were prospectively collected by a Trauma Coordinator for patients admitted with a hip fracture from time of admission to discharge. The data comprised clinical characteristics and care quality, mobility within 1 day after hip surgery, LOS during admission, and discharge destination.…”

Section: Measurementmentioning

confidence: 99%

See 1 more Smart Citation

The Ability of the Nottingham Hip Fracture Score to Predict Mobility, Length of Stay and Mortality in Hospital, and Discharge Destination in Patients Admitted with a Hip Fracture

et al. 2020

Self Cite

View full text Add to dashboard Cite

The Nottingham Hip Fracture Score (NHFS) has been developed for predicting 30-day and 1-year mortality after hip fracture. We hypothesise that NHFS may also predict other adverse events. Data from 666 patients (190 men, 476 women), aged 60.2–103.4 years, admitted with a hip fracture to a single centre from 1/10/2015 and 7/12/2017 were analysed. The ability of NHFS to predict mobility within 1 day after surgery, length of stay (LOS) find mortality, and discharge destination was evaluated by receiver operating characteristic curves and two-graph plots. The area under the curve (95% confidence interval [CI]) for predicting mortality was 67.4% (58.4–76.4%), prolonged LOS was 59.0% (54.0–64.0%), discharge to residential/nursing care was 62.3% (54.0–71.5%), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care was 64.8% (59.0–70.6%). NHFS thresholds at 4 and 7 corresponding to the lower and upper limits of intermediate range where sensitivity and specificity equal 90% were identified for mortality and prolonged LOS, and 4 and 6 for discharge to residential/nursing care, which were used to create three risk categories. Compared with the low risk group (NHFS = 0–4), the high risk group (NHFS = 7–10 or 6–10) had increased risk of in-patient mortality: rates = 2.0% versus 7.1%, OR (95% CI) = 3.8 (1.5–9.9), failure to mobilise within 1 day of surgery: rates = 18.9% versus 28.3%, OR = 1.7 (1.0–2.8), prolonged LOS (> 17 days): rates = 20.3% versus 33.9%, OR = 2.2 (1.3–3.3), discharge to residential/nursing care: rates = 4.5% vs 12.3%, OR = 3.0 (1.4–6.4), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care: rates = 10.5% versus 28.6%, 3.4 (95% CI 1.9–6.0), and stayed 4.1 days (1.5–6.7 days) longer in hospital. High NHFS associates with increased risk of mortality, prolonged LOS and discharge to residential/nursing care, lending further support for its use to identify adverse events.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Measurementmentioning

confidence: 99%

The Ability of the Nottingham Hip Fracture Score to Predict Mobility, Length of Stay and Mortality in Hospital, and Discharge Destination in Patients Admitted with a Hip Fracture

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…They reported in-patient prevalences for evidence of delirium were 20.6% in orthopaedics units, 21.2% in general internal medicine units, 24.7% in geriatrics units and 28.5% in neurology units. Prolonged LOS and mortality, as well as residential/nursing care, are high among older patients; especially those admitted with hip fractures [16] with enormous burdens to both patients and healthcare systems [17,18]. Our study observed that just over one-half of patients returned to their own home directly after discharge while more than a third of patients were transferred to rehabilitation units.…”

Section: Los Increased By Three and Six Days For Patients With 4at Smentioning

confidence: 64%

Associations of 4AT with mobility, length of stay and mortality in hospital and discharge destination among patients admitted with hip fractures

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background the 4AT (Alertness, Abbreviated Mental Test-4, Attention and Acute change or fluctuating course), a tool to screen cognitive impairment and delirium, has recently been recommended by the Scottish Intercollegiate Guidelines Network. We examined its ability to predict health outcomes among patients admitted with hip fractures to a single hospital between January 2018 and June 2019. Methods the 4AT was performed within 1 day after hip surgery. A 4AT score of 0 means unlikely delirium or severe cognitive impairment (reference group); a score of 1–3 suggests possible chronic cognitive impairment, without excluding possibility of delirium; a score ≥ 4 suggests delirium with or without chronic cognitive impairment. Logistic regression, adjusted for: age; sex; nutritional status; co-morbidities; polypharmacy; and anticholinergic burden, used the 4AT to predict mobility, length of stay (LOS), mortality and discharge destination, compared with the reference group. Results from 537 (392 women, 145 men: mean = 83.7 ± standard deviation [SD] = 8.8 years) consecutive patients, 522 completed the 4AT; 132 (25%) had prolonged LOS (>2 weeks) and 36 (6.8%) died in hospital. Risk of failure to mobilise within 1 day of surgery was increased with a 4AT score ≥ 4 (OR = 2.4, 95% confidence interval [CI] = 1.3–4.3). Prolonged LOS was increased with 4AT scores of 1–3 (OR = 2.4, 95%CI = 1.4–4.1) or ≥4 (OR = 3.1, 95%CI = 1.9–6.7). In-patient mortality was increased with a 4AT score ≥ 4 (OR = 3.1, 95%CI = 1.2–8.2) but not with a 4AT score of 1–3. Change of residence on discharge was increased with a 4AT score ≥ 4 (OR = 3.1, 95%CI = 1.4–6.8). These associations persisted after excluding patients with dementia. 4AT score = 1–3 and ≥ 4 associated with increased LOS by 3 and 6 days, respectively. Conclusions for older adults with hip fracture, the 4AT independently predicts immobility, prolonged LOS, death in hospital and change in residence on discharge.

show abstract

“…Several studies have identified factors associated with protracted hospitalization, but many of these have focused on targeted patient populations [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] or involved data collected at a single centre [ 13 , 18 , 19 , 23 , 24 , 28 , 29 , 31 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] Understanding the factors that contribute to prolonged hospitalization in a broader patient cohort may guide the development of interventions that target at risk patients, improve overall care, and reduce resource utilisation.…”

Section: Introductionmentioning

confidence: 99%

The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

Ofori‐Asenso

Mårtensson

Jones

2020

JCM

View full text Add to dashboard Cite

Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.

show abstract

Predictive model of length of stay in hospital among older patients

Abstract: A useful estimate of outcome and LOS can be made by constructing a predictive equation from information on hospital admission, to provide evidence-based guidance for resource requirements and discharge planning.

Cited by 43 publications

References 24 publications

The Ability of the Nottingham Hip Fracture Score to Predict Mobility, Length of Stay and Mortality in Hospital, and Discharge Destination in Patients Admitted with a Hip Fracture

The Ability of the Nottingham Hip Fracture Score to Predict Mobility, Length of Stay and Mortality in Hospital, and Discharge Destination in Patients Admitted with a Hip Fracture

Associations of 4AT with mobility, length of stay and mortality in hospital and discharge destination among patients admitted with hip fractures

The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

Contact Info

Product

Resources

About