Length of stay (LOS) is increasingly being recognized as an important quality measure. It reflects the total number of days a patient actually spends in the hospital until discharge and encompasses the cumulative time of the initial sickness, the treatment duration in the inpatient setting, time for testing and throughput issues, and any secondary complications that occur. LOS also determines the Medicare/Medicaid reimbursement that is given for each patient admission. Patients who have a longer LOS seem to be at a higher risk of acquiring certain additional complications in the hospital setting, regardless of their initial diagnosis. Reasons for longer than expected length of stay are multiple, and contributing factors to these “discharge delays” are not delineated clearly. A recent study of 171 patients showed that nearly 23% of patients experienced at least 1 delay in the hospital, adding to hospital costs of approximately $170,000 and financial burden. It is hoped that by identifying these associated negative outcomes and other bottleneck factors in throughput in our hospital system, we can formulate measures to improve throughput and LOS. This will not only help improve quality of patient care, patient safety, and patient education but will also have a positive financial impact.
Charts and discharge summaries of 486 patients who were hospitalized during a 2‐year period from 2007 until 2009 and discharged from a medical setting were reviewed. Only specific admissions where patients had an increased LOS greater than 5 days from their target LOS were studied. The target LOS was determined by their diagnosis based on Medicare Severity Diagnosis‐Related Groups (MSDRGs). Actual length of stays ranged from 13 to 49 days. Several complications were evaluated (as below) and were tabulated only if they occurred in the period after their target LOS.
Of the 486 patients studied, 71 patients (14.6%) developed delirium, 69 patients (14.19%) developed deep vein thrombosis, 10 patients (2%) developed pulmonary embolism, 31 patients (6.37) developed hospital‐acquired pneumonia, 17 patients (3.49) developed Clostridium difficile colitis, 90 patients (18.5%) developed sepsis, 65 patients (13.37%) developed urinary tract infection, and 10 patients (2%) developed decubitus ulcers. These complications were not part of the presentation or initial diagnosis of patients but occurred several days (or weeks in some instances) into their admission and contributed to a further increase in their length of stay.
Increased LOS is associated with significant medical and financial impact for both the patient and the medical system. Further studies with controls are underway to help clarify reasons for “discharge delays” in our hospital system so that appropriate measures can be undertaken to improve LOS and quality of care.
A. Ramaswamy, none; R. Bahuva, none; C. Alraies, none; A. Rajmanickam, none; B. Harte, none.
To cite this abstract:Ramaswamy A, Bahuva R, Alraies C, Rajamanickam A, Harte B. Review of Predictors and Negative Outcomes Associated with Patients Who Exceed Their Expected Length of Stay. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 119. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/review-of-predictors-and-negative-outcomes-associated-with-patients-who-exceed-their-expected-length-of-stay/. Accessed May 23, 2019.