Anna Marie Chang1, Judd E Hollander1, Erica Su2, Robert E Weiss2, Annick N Yagapen3, Susan E Malveau3, David H Adler4, Aveh Bastani5, Christopher W Baugh6, Jeffrey M Caterino7, Carol L Clark8, Deborah B Diercks9, Bret A Nicks10, Daniel K Nishijima11, Manish N Shah12, Kirk A Stiffler13, Alan B Storrow14, Scott T Wilber13, Benjamin C Sun15. 1. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 2. Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California. 3. Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon. 4. Department of Emergency Medicine, University of Rochester, Rochester, New York. 5. Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, Michigan. 6. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 7. Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio. 8. Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, Michigan. 9. Department of Emergency Medicine, University of Texas-Southwestern, Dallas, Texas. 10. Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina. 11. Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California. 12. Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin. 13. Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, Ohio. 14. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 15. Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: McKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown. OBJECTIVE: We sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope. METHODS: We conducted a secondary analysis of a cohort study of adults ≥60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights. RESULTS: We analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 ± 9.0 years. The median LOS was 32.6 h (interquartile range 24.2-71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9-63.6%) and the specificity was 47.8% (95% confidence interval 45.0-50.5%). CONCLUSIONS: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.
BACKGROUND: McKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown. OBJECTIVE: We sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope. METHODS: We conducted a secondary analysis of a cohort study of adults ≥60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights. RESULTS: We analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 ± 9.0 years. The median LOS was 32.6 h (interquartile range 24.2-71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9-63.6%) and the specificity was 47.8% (95% confidence interval 45.0-50.5%). CONCLUSIONS: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.
Authors: Bret A Nicks; Manish N Shah; David H Adler; Aveh Bastani; Christopher W Baugh; Jeffrey M Caterino; Carol L Clark; Deborah B Diercks; Judd E Hollander; Susan E Malveau; Daniel K Nishijima; Kirk A Stiffler; Alan B Storrow; Scott T Wilber; Annick N Yagapen; Benjamin C Sun Journal: Acad Emerg Med Date: 2017-03-17 Impact factor: 3.451
Authors: Ann M Sheehy; Ben Graf; Sreedevi Gangireddy; Robert Hoffman; Mary Ehlenbach; Cynthia Heidke; Sheilah Fields; Barbara Liegel; Elizabeth A Jacobs Journal: JAMA Intern Med Date: 2013-11-25 Impact factor: 21.873
Authors: Hao Wang; Richard D Robinson; Marco Coppola; David Fernandez; Ferran Ros; Nestor R Zenarosa; Mandy J Burton; Kathleen A Delaney Journal: Crit Pathw Cardiol Date: 2013-12