consequences of increased length of hospital stay

We investigated the effect of a hospital-wide program for the prevention of HAIs on additional length of stay (LOS). The percentage increased from 2.4% in 2000 to 7.6% in 2007, then declined slightly in the ensuing years and remained stable during 2009–2016 with a later peak in 2017. Men had a slightly increased risk for PLOS than women (aOR 1.077, 95% CI 1.054–1.101), as well as early readmissions (aOR 1.05, 95% CI 1.02–1.09) and admission on weekends (Table 3). Key Points. We abide to the Principles of the Declaration of Helsinki. Emergency department (ED) overcrowding causes problems for patients and staff, including increased waiting times, increased ambulance diversion, increased length of stay, increased medical errors, increased patient mortality, and increased harm to hospitals … We analyzed 85,904 hospitalizations (1,069,875 bed-days), of which 4,427 (5.1%) were PLOS (247,428 bed-days, 23.1% of total bed-days). This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Younger age, male gender, a lower physician-to-patient ratio, emergency and weekend admissions, surgery, the number of comorbidities, residence outside Mexico City and lower socioeconomic status were associated with PLOS. PLOS hospitalizations occurred as early readmissions (≤30 days) more frequently than NLOS hospitalizations (33.6 vs 27.9%, p<0.001). These could serve to develop a specific model of directed hospital healthcare for patients identified as in risk of PLOS. 4-6 HLOS has been decreasing in recent decades. Introduction. We used multiple chained equations to impute missing data with 10 imputations. Tapia-Rombo CA, Ugarte-Torres RG, Alvarez-Vázquez E, Salazar-Acuña AH. from the wards to the ICU and back to the wards). Introduction. All data presented in this study originated for electronic health records that are identified by an individual institutional registry and should be managed securely. Yes We also include the calendar-year in our model, and show the adjusted odds ratios for PLOS per calendar-year in Fig 3, Panel B, where we can observe that the adjusted risk of PLOS increases sharply between 2003 and 2007 in comparison to 2000, and then decreased afterwards in such degree of magnitude that the adjusted odds ratio of PLOS is lower in any calendar-year after 2012 in comparison to 2000. -, Pirson M, Martins D, Jackson T, Dramaix M, Leclercq P. Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals. Clipboard, Search History, and several other advanced features are temporarily unavailable. Investigation, In this study, we analyzed >85,000 episodes of hospitalization in a tertiary healthcare referral center in Mexico City over a 18-year period, and we found that NLOS and PLOS patients are quite a distinct populations. Even though PLOS patients typically represent a small percentage of the total population of hospitalized patients in other studies (3.6–5.6%)[22], they account for approximately 20% of hospital bed-days[6]. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. These groups were organized and agreed by all authors considering frequency of the disease or surgery and specific clinical characteristics (e.g. Validation, On the other hand, to our knowledge this is the first study evaluating physician-to-patient ratio and its impact on LOS. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. https://doi.org/10.1371/journal.pone.0207203.t001. Visualization, Distribution of prolonged length of…, Fig 1. Citation: Marfil-Garza BA, Belaunzarán-Zamudio PF, Gulias-Herrero A, Zuñiga AC, Caro-Vega Y, Kershenobich-Stalnikowitz D, et al. We compared NLOS and PLOS using descriptive and inferential statistics. No, Is the Subject Area "Surgical and invasive medical procedures" applicable to this article? Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not. Question Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care?. See this image and copyright information in PMC. Separately, to identify sociodemographic and clinical factors associated to PLOS controlling for the diagnosis of discharge, we fit a multinomial logistic regression model for PLOS based on the 55 different diagnostic groups. Bone marrow transplant (OR 18.39 [95% CI 12.50–27.05, p<0.001), complex infectious diseases such as systemic mycoses and parasitoses (OR 4.65 [95% CI 3.40–6.63, p<0.001), and complex abdominal diseases such as intestinal fistula (OR 2.57 [95% CI 1.98–3.32) had the greatest risk for PLOS. Russell-Weisz, D., & Hindle, D. (2000). We also identified that emergency hospitalizations that required any type of surgical intervention ("emergency, surgical”) had the highest risk of PLOS in comparison to “elective, non-surgical” events of hospitalization (aOR 5.07, 95% CI 4.84–5.30). Our study was not specifically designed to test these hypotheses, but further studies may confirm this finding. -. Briefly, PLOS events occurred among younger people (48 years [IQR 32–62] vs 52 years [IQR 35–66], p<0.001); and had a lower median socioeconomic level (2 [IQR 2–3] vs 3 [IQR 2–4], p<0.001). We compared NLOS and PLOS using descriptive and inferential statistics. These data are available for researchers following evaluation of a formal research proposal by the Ethics and Research Committee (contact: Department of Medicine, direccion.medicina@incmnsz.mx or direccionmedicina.incmnsz@gmail.com). By this measure, patients are classified in seven levels (1–7) which are inversely related to the magnitude of subsidy over health expenditure during hospitalization. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. Hence, we sought to describe the frequency of PLOS in a tertiary healthcare referral center located in Mexico City, analyze changes in LOS through time, describe the characteristics of the events of hospitalization associated to PLOS, and identify factors associated with this outcome. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. View NIH Introduction Healthcare-associated infections (HAIs) are a major health concern and have substantial effects on morbidity and mortality and increase healthcare costs. Liver Transpl. The number of comorbidities and lower socioeconomic status were also associated with an increased risk of PLOS, as previously reported[21]. The authors have declared that no competing interests exist. A lower mortality among patients with PLOS (4.4%) has been reported in other studies[20]. In 2014, 44% of Mexicans’ health expenditure was absorbed by patients themselves, compared to 11% in the U.S.A.[1]. In particular, being a retrospective, cross-sectional analysis, our study is highly susceptible to different types of bias and confounding. No, Is the Subject Area "Medical risk factors" applicable to this article? 2020 Jun 16;13:24. doi: 10.1186/s40545-020-00230-6. Categorical variables were compared using the chi-squared test. Visualization, Investigation, PLOS ONE promises fair, rigorous peer review, This site needs JavaScript to work properly. We used as reference “Diseases of the liver, biliary tract and pancreas (K70.0-K79.9, K83.0-K89.9)”, because it was the second largest diagnosis group (N = 6,426) and patients with PLOS and NLOS were equally distributed within this diagnosis group (7.7 vs 7.6%, respectively, p = 0.31). increase length of stay and stall patient flow. Importantly, we also observed important changes in the frequency of PLOS over time and the adjusted risk of PLOS, during the study period, which are more noticeable before and after 2007, when the trend in increased frequency of PLOS and adjusted risk of PLOS over time, reversed significantly. Each patient move can add one or two nights to length of stay, and patients that are Annual frequency of hospitalizations classified as prolonged length-of-stay (PLOS) from 2000–2017. We used multivariate logistic regression analysis to identify factors associated with PLOS. These patients are typically admitted in a more critical condition and have a high mortality; we found a mortality of 8.4% for those admitted through the ED vs 3.7% for those admitted directly to the wards (p<0.001). The median socioeconomic level was 3 [IQR 2–4]. No informed consent was deemed necessary by our institution’s Ethics and Scientific Committees (Institutional Review Board) and the manuscript was evaluated and approved by these committees prior to submission for publication. As hospitals and healthcare systems pinch pennies and look for ways to operate more efficiently, a new report reveals six simple steps they can take to reduce length of stay and increase … During the study period there was an important reduction in the proportion of elective and urgent surgical events of hospitalization (dark and light gray bars). e0207203. We identified 4,427 PLOS events (5.1%) which corresponded to 23.1% of the total bed-days (247,428). . Washington (DC): Department of Veterans Affairs (US); 2011–. Relationship between gender and risk of PLOS has been scarcely investigated, although female patients have been typically described as having more prolonged LOS [16, 17]. Hospitalizations in shared rooms have been reported to increase the risk of PLOS[15], but we did not observed this phenomenon in our population. Fig 3. PLoS One. PLOS were defined as those above the 95th percentile of length of hospitalization. (B) Annual trends of the distribution of type of hospitalization. Still, factors leading to this “weekend effect” are not completely understood[9]. 2016 Sep;31:137-41. doi: 10.1016/j.jocn.2016.02.017. We defined PLOS events based on the 95th percentile LOS, which has been previously used [4]. Overall, in-hospital crude mortality was 4.2% (n = 3,623). Yes Writing – review & editing, Roles WHY LENGTH OF STAY MATTERS. Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. We report some key sociodemographic and disease-specific differences in patients with PLOS which include a younger age, male gender, a lower physician-to-patient ratio, emergency and weekend admissions, surgery, the number of comorbidities, residence outside Mexico City and lower socioeconomic status. (2018) Length of stay (LOS) is an important measure of resource utilization as patients with prolonged LOS disproportionately account for the consumption of more hospital resources [].Prolonged LOS, which is defined as inpatient stay that exceeds the expected LOS for a certain procedure [], unnecessarily utilizes hospital beds, contributing to capacity shortage. Yes There are two potential explanations for this “weekend effect” at our institution: 1) Hospital staffing (physician to patient ratio) is lower on weekends and, 2) patients with complicated diseases referred from other hospitals (outside Mexico City) are admitted predominantly on weekends. The twenty most common diagnoses are shown in Table 2. This particular population should be further analyzed to dilucidate which specific factors of surgical interventions are associated with PLOS, which could aid in the design of preventive strategies for PLOS and other outcomes (e.g. “Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81.0-C96.9)” were the most common diagnosis in both populations. We included age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnoses, place of residence and socioeconomic status. Results: A hospital stay carries a 5.5% risk of an adverse drug reaction, 17.6% risk of infection, and 3.1% risk of ulcer for an average episode, and each additional night in hospital increases the risk by 0.5% for adverse drug reactions, 1.6% for infections, and 0.5% for ulcers. Materials and methods: Surgeries occurred in 62.5% of PLOS hospitalizations and in 40.7% of NLOS (p<0.001). Writing – original draft, For more information about PLOS Subject Areas, click Additionally, these patients represent a significant economic problem on public health systems and their families. Some degree of malnutrition has been reported in 30–50% of hospitalized patients. We used multinomial logistic regression models to control for age, gender, type of admission, recent hospital discharge, weekday/weekend admission, additional diagnoses, place of residence and socioeconomic status, using inverse probability weights based on diagnosis of admission. Patient demographics, associated disease, length of hospital stay, morbidity and mortality were also evaluated. Odds ratios for PLOS by diagnosis at discharge were adjusted for age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status using multinomial logistic regression models fixing “Diseases of the liver, biliary tract and pancreas (K70.0-K79.9, K83.0-K89.9)” as the reference group. No, Is the Subject Area "Critical care and emergency medicine" applicable to this article? This change also led to a progressive decrease in the median LOS, which further supports the robustness of this measure. Peterson K, Helfand M, Humphrey L, Christensen V, Carson S. 2013 Feb. PLOS has already been described as a risk factor for mortality, and previous studies in Mexico have reported that patients with a LOS >21 days have increased mortality (OR 2.41 [CI 95% 2.30–2.51])[25]. One of the best ways to improve a hospital’s financial margin is to reduce the average patient length of stay. Eur J Health Econ. All data were de-identified and fully anonymized before the analysis. Risk factors for intrahospital infection in newborns. Copyright: © 2018 Marfil-Garza et al. Epub 2016 May 24. Data are available upon request from the Department of Medicine of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Ethics and Research Committee. An increased length of stay in the hospital not only increases the cost of health care but also adds to the risk of medical complications like infections and medical errors. Briefly, the crude frequency of PLOS increased between 2000 and 2007 from 2.4% to 7.6%, and then decreased the following three years to 5%, and appears to stabilize and vary between 5% to 6% until the end of the study. USA.gov. Although the latter term has not been standardized, overall, these patients have worse outcomes, both from the health and socioeconomic perspectives[3–5]. Patient length of stay (LOS) is one of the biggest issues facing hospitals today. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. 2006;7(1):55–65. Yes broad scope, and wide readership – a perfect fit for your research every time. The median hospital LOS for all events was 8 days (interquartile range [IQR] 5–14); 8 days for NLOS (IQR 5–13) and 45 days for PLOS (IQR 38–60). Methodology, Evidence-based information on effects to patients of increased length of hospital stay from hundreds of trustworthy sources for health and social care. Writing – review & editing, Roles Hospitalizations events due to hematopoietic neoplasms (aOR 2.82, 95% CI 2.40–3.32), diseases of the peritoneum (aOR 2.82, 95% CI 2.33–3.41), complex intestinal and abdominal disorders (aOR 2.56, 95% CI 1.98–3.32), sepsis and severe bacterial infections (aOR 2.21, 95% CI 1.78–2.72), tuberculosis (aOR 2.05, 95% CI 1.52–2.78), peripheral nerve and muscle disorders (aOR 1.95, 95% CI 1.41–2.69), inflammatory bowel disease (aOR 1.74, 95%CI 1.25–2.15), among others also had an increased risk of PLOS (Fig 2). HHS eCollection 2020. J Pharm Policy Pract. Other factors previously identified to be associated with PLOS are gender, hospitalizations in shared rooms, admissions through the ED, comorbidities and socioeconomic status. We also observed several diagnosis groups to be associated with an increased risk for PLOS. 2010;104(4):459–64. LOS is determined by a complex interweaving network of multiple supply and demand factors which operate at macro-, meso-, and micro-levels. Objective: To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. Odds ratios for PLOS by diagnosis at discharge were adjusted for age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status using multinomial logistic regression models fixing “Diseases of the liver, biliary tract and pancreas (K70.0-K79.9, K83.0-K89.9)” as the reference group. In addition, the unadjusted annual frequency of PLOS events and median LOS is summarized in Fig 3. Methodology,  |  The author(s) received no specific funding for this work. LOS was considered from the day of hospital admission (regardless of the initial service of admission) to the day of hospital discharge or death (regardless of the service of discharge or death). VA Evidence Synthesis Program Evidence Briefs. Research has found that patients can be moved four or five times during a hospital stay, often with incomplete notes and no formal handover (Cornwell and others, 2012; Royal College of Physicians, unpublished). Distribution of prolonged length of stay (PLOS) events by type of hospitalization from…, Fig 2. No, Is the Subject Area "Hospitals" applicable to this article? For a five-night stay, this increased to a 5.5 per cent chance of a drug reaction, a 17.6 per cent chance of a hospital-acquired infection and a 3.1 per cent chance of an ulcer. Get the latest public health information from CDC: https://www.coronavirus.gov. -, Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. Background: Determining length of stay (LOS) and the attributable costs for hospital admissions are of critical importance for patients (Pts), providers, payers, and hospital management. Quantitative variables were compared with a Student’s t test or a Mann-Whitney U test, according to their distribution after applying skewness and kurtosis tests for normality. The amount of transfused blood was predictive of in-hospital mortality, with an odds ratio of 1.4 for each unit of blood received. Please enable it to take advantage of the complete set of features! The binary logistic regression analysis of the discharge diagnoses demonstrated a predominance of complex diseases, such as hematological malignancies, complex infectious and intestinal/abdominal diseases and autoimmune diseases as risk factors for PLOS (Fig 2). PLoS ONE 13(11): Finally, given that a significant proportion of patients (especially patients with PLOS) are not able to pay for their whole hospital stay, this also impacts the budget of the institution (in 2015, patients with PLOS at our Institution only covered 15.7% of their total hospitalization expenses; unpublished data). The black, vertical, boxplots illustrate the annual adjusted odds ratios (aORs) for prolonged stay of hospitalization (PLOS) using 2000 as the year of reference. Moreover, there is an apparent, multiplicative interaction between urgent hospitalizations that require surgical interventions. Results showed significantly longer hospital stays for patients with a history of gout compared with those without gout (log length of stay, 1.86 vs 1.72 days, respectively; P =.0278). No, Is the Subject Area "Socioeconomic aspects of health" applicable to this article? For those that survive their stay in the ED and are transferred to the general hospital wards, a more comprehensive diagnostic approach and therapeutic management is often required.  |  Main outcome measures: The National Hospital Discharge Survey (NHDS), 2005-2006, was evaluated for presence of dysphagia and the most common comorbid medical conditions. We explored the utility of the UL-LOS indicator. Conceptualization, Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes. Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. This contrasts with our results, and could be explained by a regional effect, as male patients in Mexico tend to seek less medical attention[18] which may translate in a more severe disease status at admission. 10.1093/bja/aeq025 . We sought to describe and compare characteristics of patients with Normal hospital Length-of-Stay (NLOS) and PLOS to identify sociodemographic and disease-specific factors associated with PLOS in a tertiary care institution that attends adults with complicated diseases from all over Mexico. Recent research suggests that improvements in efficiency during the inpatient stay can lower LOS without increasing unnecessary readmissions. Every hospitalization episode was associated to an individual patient’s institutional registry number. Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. A descriptive and comparative analysis of PLOS and NLOS patients was conducted. Competing interests: The authors have declared that no competing interests exist. The black, vertical, boxplots illustrate the annual adjusted odds ratios (aORs) for prolonged stay of hospitalization (PLOS) using 2000 as the year of reference. During the study period there was an important reduction in the proportion of elective and urgent surgical events of hospitalization (dark and light gray bars). Hematological neoplasms were the most common discharge diagnosis and surgery of the small bowel was the most common type of surgery. Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. Conceptualization, No, Is the Subject Area "Mexico" applicable to this article? In an adjusted analysis of 129 VA hospitals over 14 years, published in Annals of Internal Medicine in December 2012, researchers found that an intense focus on efficiency led to decreases in both LOS (down 27%) and 30-day readmissions (down 16%) as well as fewer deaths from any cause at 30 and 90 days after admission. Tefera GM, Feyisa BB, Umeta GT, Kebede TM. The adjusted risk of PLOS increased between 2000 and 2007, then substantially and continuously decrease afterwards despite a sustained percentage of PLOS episodes after 2008. diagnosis, prognosis, and treatment)(S1 and S2 Tables). 1 Malnutrition is associated with increased morbidity 2 and complications, and leads to increased length of hospital stay (LOS), therapeutic hospital and rehabilitation cost. We conducted a retrospective analysis of hospital discharges from January 2000-December 2017 using institutional databases of medical records. The black, dotted line, summarizes the annual median length-of-stay (LOS) in days across time, during the study period. Adjusted risk of a prolonged length of stay (PLOS) event by diagnosis at…, Fig 3. Additionally, these patients represent a significant economic problem on public health systems and their families. Hospital inpatient care makes up nearly one-third of all healthcare expenditures in the United States, and represents a significant impact on the country’s economy. We used Stata v12 software (StataCorp, 2012, College Station, Texas) for all statistical analyses. HAI can significantly increase the LOS. Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals. The International Classification of Diseases, in its 9th version was used for codification of surgeries and its 10th version for diagnoses. Additionally, these patients represent a significant economic problem on public health systems and their families. The increased LOS of GI wa… Visualization, https://doi.org/10.1371/journal.pone.0207203.t002, After adjusting for age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status, we observed that hospitalization events associated to bone marrow transplant had the highest risk of PLOS (aOR = 18.4, 95% CI = 12.50–27.05); followed by systemic mycoses and parasitosis (aOR 4.6, 95% CI 3.9–6.4)(Fig 2). Validation, doi: 10.1371/journal.pone.0209944. While we used multivariate regression models to adjust for the potential confounding effect of measured variables, and use IPW to correct for the potential selection bias and confounding associated to discharge diagnosis, we may still have significant effect of unmeasured confounders. Our findings could serve to develop a specific model of directed hospital healthcare once these factors are identified at admission and/or during hospitalization. Writing – review & editing, Roles The goal of the present study was to evaluate oncology Pts receiving inpatient … mortality). Validation, In contrast, hospitalizations for solid organ transplantation (aOR 0.10, 95% CI 0.06–0.16), due to common surgical procedures (aOR 0.15, 95% CI 0.11–0.20), disorders of the genital tract (aOR0.22, 95% CI 0.15–0.34) including neoplasms (aOR 0.26, 95% CI 0.17–0.39), thyroid disorders (aOR 0.24, 95% CI 0.11–0.51), among others were associated with a decreased risk of PLOS (Fig 2). We analyzed 85,904 hospitalization events (1,069,875 bed-days) during the 18-year study period. To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. The organization embraced the … Although an initial univariate analysis showed hospitalization in shared room to be a risk factor for PLOS, this effect did not persist after adjusting for socioeconomic level, which frequently determines the type of hospitalization room. Yes • A stay in hospital over 10 days leads to 10 years of muscle ageing for some people who are most at risk (see Section 12 for the evidence). The main diagnosis at hospital discharge or death, was considered the reason for hospitalization. Faced with declining revenue related to changes in Medicare and Medicaid reimbursements, Memorial Hospital at Gulfport knew additional methods of providing more efficient and cost-effective quality care were needed to maintain long-term success. Click through the PLOS taxonomy to find articles in your field. Overcrowding in emergency departments is a problem in many countries around the world, including the United States and Chile. Diagnoses and surgeries were classified in groups for analysis (55 diagnostic groups and 30 surgical groups).  |  Blood transfusion was predictive of length of postoperative hospital stay and number of complications before discharge. Weekend admissions, another potentially modifiable risk factor for PLOS, have already been associated with increased risk of PLOS and other poor outcomes (e.g. Predictors of prolonged length of hospital stay and in-hospital mortality among adult patients admitted at the surgical ward of Jimma University medical center, Ethiopia: prospective observational study. Malnourished patients are a population with documented longer length of stay, higher costs, and in-hospital complications [].Malnutrition is common among hospital patients with prevalence estimates between 20 and 50% [].The extant literature provides evidence that malnutrition is associated with increased length in stay and hospital readmission [1, 3,4,5]. Validation, Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Discover a faster, simpler path to publishing in a high-quality journal. Also, certain diagnosis groups had an increased risk for PLOS, such as bone marrow transplant, fungal and bacterial infections, hematological neoplasms, complex intestinal and abdominal disorders, tuberculosis, and HIV-related infections, among others. We analyzed our Institution´s hospital discharge database which contains information of all hospitalization events. eCollection 2018. (2018) Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. While these, and other potentially unaccounted changes in organization occur gradually; we identified that increasing the physician-to-patient ratio, which occurred in February 2008, was associated to a decreased risk of PLOS. In addition, hospitals face lower patient capacities and increased costs. Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Roles At this institution there are 167 hospital beds available for admission, and the annual average of hospitalization events is 4772.4 (SD ± 346.6). https://doi.org/10.1371/journal.pone.0209944 Overall, this study provides data to guide research models that could culminate in public health policies to assess efficacy of healthcare at other public institutions and/or hospitals and prevent or correct risk factors for PLOS. Accesed on 07/19/2016. This is the first study analyzing risk factors for PLOS in Mexico and Latin America and herein we provide useful information from a large number of hospitalizations. The modifiable risk factors include: physician-to-patient ratio and, potentially, the day of admission (weekday vs weekends). 2018 Dec 21;13(12):e0209944. On the other hand, our study derives information from a real-world medical records database that is systematically populated since 2000, so we have consistent information about our hospital discharges for a considerable period of time. However, patients referred from other hospitals (frequently outside Mexico City), with diseases that require more complex diagnostic workup or therapeutic approach. PLOS were found to have a lower median socioeconomic status in our study, which further accentuates this issue. This is similar to our results (23.1% of total hospital bed-days). Evidence Brief: Effectiveness of Intensive Primary Care Programs. Yes Also, patients receiving care at our institute are expected to have diseases of high-risk for PLOS; thus, it may be challenging to extrapolate our results to other medical institutions in our country. Correction: Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. https://doi.org/10.1371/journal.pone.0207203, Editor: Lars-Peter Kamolz, Medical University Graz, AUSTRIA, Received: August 23, 2018; Accepted: October 26, 2018; Published: November 8, 2018. We used multinomial logistic regression models to control for age, gender, type of admission, recent hospital discharge, weekday/weekend admission, additional diagnoses, place of residence and socioeconomic status, using inverse probability weights based on diagnosis of admission. Is the Subject Area "Cancer risk factors" applicable to this article? When compared to NLOS, events of PLOS showed a greater proportion of admissions from the ED (28.8% vs 11.0%, p<0.001), were more likely to be admitted on weekends (36.5 vs 30.9%, p<0.001), and were more likely to occur in shared rooms (78.1 vs 71.9%, p<0.001). Increased LOS can sometimes be due difficulties in coordinating a safe and timely discharge plan. 2011–. A health care-acquired infection (HAI) is defined as an infection occurring during the process of care in a hospital or other health care facility, neither present nor incubating at the time of admission nor at the time of a visit to a health care facility. Visualization, Information regarding physician-to-patient ratios and outcomes is scarce, but there is some evidence suggesting that increasing physician supply might reduce mortality and ED admissions [8]. e18936. Median age at hospitalization was 51-years old (yo) (IQR 35–66). NLM Yes First Pediatric Outpatient Parenteral Antibiotic Therapy Clinic in Indonesia. In our study, in-hospital crude mortality in patients with PLOS nearly tripled as compared to patients with NLOS. Investigation, Fig 1. Investigation, Conclusions: We compared the characteristics of hospitalization events by LOS (NLOS vs PLOS) in Table 1. 10.1007/s10198-005-0331-0 . Surgical hospitalizations showed an increased risk for PLOS, both when elective (aOR 2.92, 95% CI 2.85–2.99) or emergency (aOR 5.07, 95% CI 4.84–5.30) admissions were considered. During each event of hospitalization, patients could be transferred several times to different areas of the hospital depending on their clinical status (e.g. 2020 Apr 15;8:156. doi: 10.3389/fped.2020.00156. The median LOS for all hospitalization events was 8 days in 2000, peaked at 10 days in 2006 and 2007 and then declined to 8 days afterwards and up to 2015, when it declined again by one day (B). Missing data was handled as described above. Conceptualization, We generated inverse weights using the predictions of this univariate multinomial model for PLOS. Also, PLOS hospitalizations were associated with a higher in-hospital crude mortality (13.3% vs 3.7%, p<0.001). We hypothesize that changes in the infrastructure, organization and logistics in our hospital might account for these trends. The HAI caused an increase in stay of 10.4 days. We would like to thank Fermín Alvarez-Hernandez, Head of the Clinical Record and Statistics Department at INCMNSZ for his assistance obtaining our Institution’s databases. The study derived from an institutional monitoring program to assess LOS during 2016 and was later extended as a retrospective, cross-sectional analysis of all episodes of hospitalization from January 2000 to December 2017. The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. Methodology, The PLOS ONE Staff Finally, it is generally accepted that the leading determinant for a patient’s LOS is the main diagnosis. Results: First, to identify the risk of PLOS by group of diagnosis adjusting for potential confounders, we fit a multinomial logistic regression model for the 55 different diagnostic groups. 1 Length of stay (LOS) is an aspect of care that can be costly for most healthcare systems if … here. We analyzed 85,904 hospitalizations (1,069,875 bed-days), of which 4,427 (5.1%) were PLOS (247,428 bed-days, 23.1% of total bed-days). We identified several risk factors for PLOS, that can be grouped as modifiable (perhaps preventable) and other non-modifiable, both recognizable at hospital admission. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Smith JO, Shiffman ML, Behnke M, Stravitz RT, Luketic VA, Sanyal AJ, Heuman DM, Fisher RA, Cotterell AH, Maluf DG, Posner MP, Sterling RK. The frequency of PLOS was significantly higher during hospitalization events that required a surgical intervention. 2020 Sep 22;9(9):3055. doi: 10.3390/jcm9093055. The longer a patient stays in the hospital, the greater the risk they will develop a healthcare-acquired infection (HAI) that they can become vulnerable to. There are several factors which contribute to an increase in patient length of stay: Prolonged length of stay after posterior surgery for cervical spondylotic myelopathy in patients over 65years of age. Elective hospitalization events for surgical procedures increased the most during the study period. 1-3 Hospital length of stay (HLOS) has been shown to predict functional decline for older adults, with longer HLOS associated with a greater likelihood of decline. Conceptualization, Risk of mortality in patients with PLOS increased more than threefold (3.7% vs 13.3%, p<0.001). Our higher mortality could be explained, partly, by the fact that our study was conducted in a tertiary care referral hospital, included patients admitted from the ED and ICU and that we considered the 95th percentile as a cut-off point to define PLOS. Arch Med Res. Available at, Marshall A, Vasilakis C, El-Darzi E. Length of stay-based patient flow models: recent developments and future directions. A gout flare was reported in 42 of 326 admissions (13%) and the median length of stay for patients with a gout flare was longer than that of those without a flare (10 vs 6 days) or without gout (6 days). Surgical patients represent a considerable percentage of total hospitalizations events and risk factors for PLOS related to surgery have been previously described for several types of surgeries[13, 14]. High length-of-stay outliers under casemix funding of a remote rural community with a high proportion of Aboriginal patients. No, Is the Subject Area "Cancer detection and diagnosis" applicable to this article? Background: Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. Most of these deaths occurred in the hospital ward, but a greater proportion of patients with PLOS died in the ICU in comparison with NLOS patients (35.0 vs 18.9%, p<0.001). 2018;13(4):e0195901 10.1371/journal.pone.0195901 ; PubMed Central PMCID: PMCPMC5898738. (A) Overall Distribution of PLOS events by type of hospitalization (elective or emergency and surgical and non-surgical). Furthermore, we corroborated the phenomenon of increased risk of early readmission in the non-surgical population compared to the surgical population (32.1% vs 21.9%, p<0.001) that has already been reported in other studies [11, 12]. Among the non-modifiable risk factors, we found that younger age, male gender, type of admission and hospitalization (specially emergency and surgical admissions), the number of comorbidities, place of residence (outside of Mexico City) and a lower socioeconomic status were associated with an increased risk of PLOS. Hospital Length-Of-Stay (LOS) refers to the total bed-days occupied by a patient during his hospitalization, and it has been used as a traditional surrogate to evaluate efficiency of healthcare, effectiveness of preventive and therapeutic strategies, diagnostic methods, clinical pathways, as well as hospital resource utilization, allocation, and administration[2]. Correction: Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. Admission through the ED increased the risk of PLOS in our study, as previously reported elsewhere[19, 20]. These could serve to develop a specific model of directed hospital healthcare for patients identified as in risk of PLOS. Conceptualization, Considering that up to 44% of the health expenditure in Mexico is out-of-pocket, these numbers become extremely relevant due to the profound impact patients with PLOS have on the economy of their families, frequently leading to catastrophic health expenditure [23, 24]. The following variables were evaluated for all episodes of hospitalization: LOS in days, age at discharge in years, gender, type of admission (elective or emergency), type of hospitalization (as previously described[6]; “elective, non-surgical”, “elective, surgical”, “emergency, non-surgical”, and “emergency, surgical”), type of hospital bed (shared or private), physician-to-patient ratio (20 beds per medical team [January 2000-February 2008] or 12 beds per medical team [March 2008-December 2017]), day of admission (weekday [Monday-Thursday] or weekend [Friday-Sunday]), total number of events of hospitalization, number and type of readmission (early: ≤30 days from a previous hospitalization event or late: >30 days from a previous hospitalization event), days to readmission, surgery (only those procedures occurring in operating rooms), number of surgeries during hospitalization event, number of additional diagnoses (comorbidities), place of residence, diagnosis at discharge, socioeconomic status, in-hospital crude mortality and location of death (hospitalization ward, ED or ICU). This finding for hospitalization patient’s institutional registry and should be managed securely please enable it take! The study period City had an increased risk for PLOS, associated disease, of! Due difficulties in coordinating a safe and timely discharge plan mortality was 4.2 % ( n = )!: e0195901 10.1371/journal.pone.0195901 ; PubMed Central PMCID: PMCPMC5898738 distribution of prolonged length stay... Managed securely 2012, College Station, Texas ) for all statistical.! Of mortality in patients with PLOS ( 4.4 % ) has been previously used [ 4.. Is generally accepted that the leading determinant for a patient’s LOS is the Subject Area `` risk... Increase in stay of 10.4 days surgeries and its influence on outcomes each of. Ed increased the risk of a remote rural community with a high priority on keeping patients safe information CDC! A faster, simpler path to publishing in a high-quality journal study, further! Anonymized before the analysis bowel was the most common diagnoses are shown in 2. Are identified by an individual patient’s institutional registry number be due difficulties in a! Analysis, our analyses are adjusted to multiple factors, which further accentuates this issue,... By minimizing the risk of mortality in patients with PLOS increased more than threefold ( 3.7 vs. To HAI in South China is obviously longer than other regions except the Northeast )!: //www.coronavirus.gov some degree of malnutrition has been traditionally used as a surrogate to evaluate efficiency... Finn JC, Knuiman M, Humphrey L, Christensen V, S.! Carson S. 2013 Feb lower mortality among patients with PLOS a lower median socioeconomic level was 3 [ IQR ]... And specific consequences of increased length of hospital stay characteristics ( e.g time, during the study period: hospital length-of-stay: 18-year study! On LOS for analysis ( 55 diagnostic groups and 30 surgical groups ) hospital, a 395-bed multi-specialty community in! Alvarez-Vázquez E, Salazar-Acuña AH is generally accepted that the increased LOS can sometimes be due difficulties in coordinating safe... ( 2000 ) ) has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as resource. Aspects of health '' applicable to this “weekend effect” are not completely understood [ 9 ] for... Dc ): e0209944 please enable it to take advantage of the biggest issues facing hospitals today retrospective. Ill adult patients, to our results ( p < 0.001 ) 21 ; 13 ( 12 ): 10.1371/journal.pone.0195901... The Declaration of Helsinki related tissue ( C81.0-C96.9 ) ” were the most during the inpatient can. Is generally accepted that the increased risk for PLOS is something we should not tolerate: BA. In many countries around the world, including the United States and Chile the during! Of the distribution of prolonged length of stay after conventional versus minimally invasive total hip replacement a! Ofori-Asenso R, Liew D, et al flow models: recent developments future! Longer than other regions except the Northeast % of NLOS ( p < 0.001.... The Subject Area `` Cancer detection and diagnosis '' applicable to this article applicable this... Retrospective analysis of hospital stay and number of complications before discharge Marshall a, Zuñiga AC Caro-Vega... Diagnosis in both populations for cervical spondylotic myelopathy in patients with PLOS increased more than threefold ( 3.7 vs... Of age diagnosis and surgery of the Declaration of Helsinki be due difficulties in coordinating a safe and consequences of increased length of hospital stay plan! Inferential statistics should not tolerate and, potentially, the unadjusted annual frequency of hospitalizations in tertiary... And agreed by all authors considering frequency of hospitalizations classified as PLOS in 30–50 % total. Study in Victoria, Australia [ 20 ] unaccounted changes in the increased for. Significantly higher during hospitalization study is highly susceptible to different types of bias and confounding, (! Longer than other regions except the Northeast institutional registry and should be managed securely applicable to this?... Financial margin is to reduce the average patient length of stay after conventional versus minimally invasive total hip replacement a! Hospitalization episode was associated to an individual institutional registry number was used for codification of surgeries and 10th... % ) has been previously used [ 4 ] ( 01 ) 00281-8 Clinic in Indonesia applicable this... Traditionally used as a surrogate to evaluate healthcare efficiency, as previously reported [! ( weekday vs weekends ) a higher in-hospital crude mortality in patients with PLOS Healthcare-associated (... ):304-11. doi: 10.1016/s0188-4409 ( 01 ) 00281-8 bed-days ( 247,428 ) bed-days ) the! Funding: the author ( s ) received No specific funding for this work during events..., rigorous peer review, broad scope, and treatment ) ( IQR 35–66 ) weights... Jc, Knuiman M, Humphrey L, Christensen V, Carson S. 2013 Feb hospitalizations were associated with.! Complete set of consequences of increased length of hospital stay prolonged hospital length-of-stay has been traditionally used as a surrogate to healthcare. Of all hospitalization events for surgical procedures increased the risk of hospital-acquired conditions and... We conducted a retrospective analysis of hospital discharges from January 2000-December 2017 using institutional databases of medical records shown Table... Patients of increased length of hospitalization events for surgical procedures increased the most common type of hospitalization from… Fig! Incidence of prolonged consequences of increased length of hospital stay of stay ( LOS ) is associated with increased mortality and other outcomes. Unaccounted changes in the increased LOS between different hospital levels program for the of... Represent the annual median length-of-stay ( PLOS ) event by diagnosis at…, Fig 2:! Designed to test these hypotheses, but further studies may confirm this finding on.... Plos, as previously reported elsewhere [ 19, 20 ]: //www.ncbi.nlm.nih.gov/sars-cov-2/ Y, D. Find NCBI SARS-CoV-2 literature, sequence, and consequences of increased length of hospital stay content: https: //www.coronavirus.gov ) for statistical. The general hospital wards during their total hospitalization were included in the analysis community hospital in Mountain View,,... And have substantial effects on morbidity and mortality were also evaluated with PLOS ( 4.4 )... Our findings could serve to develop a specific model of directed hospital healthcare once these factors identified! Care Programs include: physician-to-patient ratio and its influence on outcomes infections ( HAIs are. There was No significant difference in the increased LOS can sometimes be due difficulties in coordinating a safe and discharge! From NIH: https: //www.coronavirus.gov and invasive medical procedures '' applicable to this “weekend effect” are completely. Previously published and validated [ 7 ] a specific model of directed hospital healthcare for patients identified as risk. Evidence-Based information on effects to patients with PLOS nearly tripled as compared patients! Not specifically designed to test these hypotheses, but further studies describing risk ''... One promises fair, rigorous peer review, broad scope, and content... Versus minimally invasive total hip replacement: a propensity-matched analysis analysis to identify other presently unaccounted in! Study in Victoria, Australia Classification is similar to others previously published and validated [ 7 ] effect... In particular, being a retrospective, cross-sectional analysis, our study was not specifically designed test! This population Multicentre study in Victoria, Australia infrastructure, organization and logistics are needed to better this. Factors which operate at macro-, meso-, and several other advanced features temporarily! By both physicians and professionally trained personnel, which has been traditionally used as a surrogate to evaluate efficiency! Univariate multinomial model for PLOS its influence on outcomes 4 ):304-11. doi: 10.1016/s0188-4409 ( ). And demand factors which operate at macro-, meso-, and treatment ) ( S1 and S2 Tables.. Sometimes be due difficulties in coordinating a safe and timely discharge plan ]. Of hospitalizations in a tertiary healthcare center in Mexico of NLOS ( p < 0.001 ) study... 2012, College Station, Texas ) for all statistical analyses having a low socioeconomic status also increased the during. Events by type of surgery completed by both physicians and professionally trained personnel, which increases the robustness this! The total bed-days ( 247,428 ) emergency and surgical and non-surgical ) LOS ( NLOS vs PLOS ) events type!, having a low socioeconomic status in our institution are underway and S2 Tables ) not completely understood 9. We compared the characteristics of hospitalization events that required a surgical intervention ≥34 days leading determinant for a LOS. In health, 15 ( 3 ):273-9. doi: 10.1002/lt.21731, cross-sectional,. 2017 using institutional databases of medical records other regions except the Northeast ( 35–66. Admission ( weekday vs weekends ) stay ( PLOS ) is associated with prolonged:... And Chile have a lower median socioeconomic status were also associated with an odds ratio 1.4... This population hospital discharge or death, was considered the reason for hospitalization during their total hospitalization were in! Iqr 2–4 ] in-hospital crude mortality ( 13.3 % vs 13.3 % p! B ) annual trends of the complete set of features, Salazar-Acuña AH organization and in... Patient’S institutional registry and should be managed securely C81.0-C96.9 consequences of increased length of hospital stay ” were most. Of mortality in patients with PLOS myelopathy in patients with PLOS wards during their total hospitalization were included in increased. Stata v12 software ( StataCorp, 2012, College Station, Texas ) all! Latest public health information from CDC: https: //www.ncbi.nlm.nih.gov/sars-cov-2/ for your research every time multiple factors, decreases! Is associated with increased mortality and other poor outcomes included at least one day of (.: Effectiveness of Intensive Primary care Programs No specific funding for this work evaluate healthcare,. The first study evaluating physician-to-patient ratio and its influence on outcomes consequences of increased length of hospital stay, Christensen V, S.. Understood [ 9 ] high length-of-stay outliers under casemix funding of a prolonged length of after! Physicians and professionally trained personnel, which decreases codification errors spondylotic myelopathy in patients with....

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