Screening for older inpatients at risk for long length of stay: which clinical tool to use?

Abstract

Background Screening for inpatients at risk for long length of stay (LOS) is the first step of an effective hospital care plan for older inpatients. This study aims, in older adults admitted to a geriatric acute care ward, to examine and compare the 6-item brief geriatric assessment (BGA) and the “ Programme de Recherche sur l’Intégration des Services pour le Maintien de l’Autonomie ” (PRISMA-7) risk levels with long LOS, and to establish their performance criteria (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios) for LOS. Methods Based on an observational, retrospective, cohort design, 166 inpatients aged ≥75 admitted to a geriatric acute care ward of a McGill University-affiliated hospital (Montreal, Quebec, Canada) were recruited. The risk levels of the 6-item BGA (low, moderate and high) and the PRISMA-7 (low versus high) were calculated from a baseline assessment. The LOS was subsequently calculated in number of days. Results Only the 6-item BGA high risk level was associated with a long LOS (Odds ratio = 1.1 with P = 0.028 and Hazard ratio = 2.1 with P = 0.004). Kaplan-Meier distributions showed that there was no significant difference in the delay of hospital discharge between the low and high-risk level reported by the PRISMA-7 ( P = 0.381), whereas the 6-item BGA three risk levels differed significantly ( P = 0.008), with individuals at high risk levels being discharged later when compared to those with low ( P = 0.001) and moderate ( P = 0.019) risk levels. Both tools’ performance criteria were poor (i.e., < 0.70), except for PRISMA-7’s sensitivity which was 100%. Conclusion The 6-item BGA risk levels were associated with LOS, low risk-level being associated with short LOS and high-risk level with long LOS, but no association was reported with the PRISMA-7 risk levels. Both tools had poor performance criteria for long LOS, suggesting that they cannot be used as prognostic tools with current scientific knowledge.

Predictive validity of PRISMA-7 as a screening instrument for frailty in a hospital setting

“…PRISMA-7 has to our knowledge never been evaluated in Denmark and has only in very few studies been evaluated in an in-hospital setting. 12 13 Our main finding, that PRISMA-7 even in a selected hospital population can identify a group of patients with a higher need of hospital treatment and care in the community, renders it plausible that PRISMA-7 can be used to identify in-hospital patients that may benefit from further geriatric assessment.…”

“…11 Beauchet et al evaluated PRISMA-7 as a predictor for length of stay among patients admitted to a geriatric acute ward, and found no significant association between length of stay and PRISMA score. 12 Elliott et al performed a feasibility study in the emergency department with use of clinical vignettes and concluded that PRISMA-7 as well as other tested instruments was quick, simple and easy to use. 13 PRISMA-7 has been translated into several languages and validated in several countries, but not, to our knowledge, in any Scandinavian setting.…”

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

“…In our study, the median length of hospital stay in the total cohort was 9.0 (4.0;16.0) days which is comparable to other older patient cohorts. The median stay in hospital was between 5 and 14 days in older patients admitted to geriatric and internal medicine wards [8,17,22,43,44]. In a previous study analyzing 419 patients aged ≥70 years from geriatric wards [28], higher age, number of admission diagnoses, incontinence, and ADL impairment predicted a longer hospital stay.…”

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

“…In our study, the median length of hospital stay in the total cohort was 9.0 (4.0;16.0) days which is comparable to other older patient cohorts. The median stay in hospital was between 5-14 days in older patients admitted to geriatric and internal medicine wards [8,17,22,43,44]. In a previous study analyzing 419 patients aged ≥70 years from geriatric wards [28], higher age, number of admission diagnoses, incontinence, and ADL impairment predicted a longer hospital stay.…”