Kim O'Sullivan1, Johan Martensson2,3, Raymond Robbins4, K J Farley5, Doug Johnson6,7,8, Daryl Jones2,9,10. 1. Director Patient Flow, Austin Health, Melbourne, Victoria, Australia. 2. Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia. 3. Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. 4. Department of Administrative Informatics, Austin Health, Melbourne, Victoria, Australia. 5. Intensive Care, Western Health, Melbourne, Victoria, Australia. 6. Department of General Medicine, Austin Health, Melbourne, Victoria, Australia. 7. Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia. 8. Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. 9. School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 10. Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Patients admitted to acute care hospitals may have multiple comorbidities, and a small proportion may stay for a protracted period. AIMS: To assess the proportion of hospital patients who are long stay (≥14 days) and evaluate associations with baseline variables and subsequent inpatient morbidity and mortality. METHODS: This is a retrospective observational study of patients aged ≥18 years staying in hospital for at least 24 h between 1 July 2013 and 30 June 2014. RESULTS: There were 22 094 admissions in 15 623 patients. The median (interquartile range (IQR)) length of stay (LOS) was 4 (2-8) days, and 10% had a LOS >16 days. Long-stay admissions comprised 13.1% of admissions but used 49.1% of bed days. Long-stay admissions were more likely to be associated with intensive care unit admission (21.2 vs 6.0%), medical emergency team review (20.5 vs 4.3%) and a longer duration of mechanical ventilation (P < 0.0001 all comparisons). Long-stay patients were more likely to develop in-hospital complications, were more likely to die in hospital (8.2 vs 3.1%) and were less likely to be discharged home (P < 0.001 all comparisons). Multiple variable analysis revealed several associations with prolonged stay, including multiple admissions in the study period, the nature of the admitting unit, the Charlson comorbidity index at admission, admission from another hospital and any history of smoking. CONCLUSIONS: Patients staying at least 14 days comprised one seventh of hospital admissions but used half of bed days and suffered increased in-hospital morbidity and mortality. Several pre-admission associations with prolonged stay were identified.
BACKGROUND:Patients admitted to acute care hospitals may have multiple comorbidities, and a small proportion may stay for a protracted period. AIMS: To assess the proportion of hospital patients who are long stay (≥14 days) and evaluate associations with baseline variables and subsequent inpatient morbidity and mortality. METHODS: This is a retrospective observational study of patients aged ≥18 years staying in hospital for at least 24 h between 1 July 2013 and 30 June 2014. RESULTS: There were 22 094 admissions in 15 623 patients. The median (interquartile range (IQR)) length of stay (LOS) was 4 (2-8) days, and 10% had a LOS >16 days. Long-stay admissions comprised 13.1% of admissions but used 49.1% of bed days. Long-stay admissions were more likely to be associated with intensive care unit admission (21.2 vs 6.0%), medical emergency team review (20.5 vs 4.3%) and a longer duration of mechanical ventilation (P < 0.0001 all comparisons). Long-stay patients were more likely to develop in-hospital complications, were more likely to die in hospital (8.2 vs 3.1%) and were less likely to be discharged home (P < 0.001 all comparisons). Multiple variable analysis revealed several associations with prolonged stay, including multiple admissions in the study period, the nature of the admitting unit, the Charlson comorbidity index at admission, admission from another hospital and any history of smoking. CONCLUSIONS:Patients staying at least 14 days comprised one seventh of hospital admissions but used half of bed days and suffered increased in-hospital morbidity and mortality. Several pre-admission associations with prolonged stay were identified.
Authors: Masahiko Yazawa; Orsolya Cseprekal; Ryan A Helmick; Manish Talwar; Vasanthi Balaraman; Pradeep S B Podila; Sallyanne Fossey; Sanjaya K Satapathy; James D Eason; Miklos Z Molnar Journal: Ren Fail Date: 2020-11 Impact factor: 2.606
Authors: Sonya Osborne; Gai Harrison; Angela O'Malia; Adrian Gerard Barnett; Hannah E Carter; Nicholas Graves Journal: BMJ Open Date: 2018-12-22 Impact factor: 2.692