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Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study. Conclusions Prolonged ICU stay is an important predictor of adverse immediate, short-term, and long-term outcomes after cardiac operations. The causes recorded by the case managers were based on individual judgments without any consensus process.  JR, Rothschild The trauma registry, billing databases, and medical records of trauma admissions were reviewed.  RM, Goode  |  2015 Jun;52(5):471-7. doi: 10.3109/02770903.2014.984843. Main Outcomes and Measures  All Rights Reserved. Peterson  R, Bates Cross-sectional study of hospitalizations of patients <18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. 2014 Aug;23(4):384-401. doi: 10.1177/1054773813487373. Both groups had similar Injury Severity Scores, Revised Trauma Scores, baseline comorbidities, and in-hospital complication rates. Statistical significance was defined as P < .05. Design  In-hospital mortality was lower for ExProH patients. Definitions and DRG reporting requirements. Because the net margin is a measure of both profitability and cost control, the implication of our findings is that ExProH is a major driver of increased consumption of hospital resources and health care costs, while producing a negative financial impact on trauma centers. People who cannot adequately care for themselves are more likely to have longer stays in hospital and end up being sent to a nursing home after discharge.  EL. Of 3237 trauma patients admitted during the study period, 155 (5%) experienced ExProH.  R, Cohen Level I academic trauma center.  EJ. Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. Similar conclusions were reached by Brasel et al,19 who examined 120 trauma patients for discharge delays, defined as “a discharge-ready patient not discharged within 24 h.”19 The authors found no difference in injury severity, age, and comorbidities between the delayed and nondelayed groups. Clin Nurs Res. In a classic prospective study of more than 1000 patients with documented in-hospital complications in a university medical service, Schimmel1 concluded that the risk of complication was directly related to the length of time spent in the hospital.  C, Krizek All Rights Reserved.  Jr, Sanchez Accessibility Statement, Table 1. Analysis and interpretation of data: Hwabejire, Kaafarani, Verge, Alam, Velmahos. Reasons for delayed discharge of trauma patients. Crossref Medline Google Scholar; 32. Buda S, Tolksdorf K, Schuler E, Kuhlen R, Haas W. BMC Public Health. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Ryskina KL, Dynan L, Stein R, Fieldston E, Palakshappa D. Acad Pediatr. This can allow comparison with results from other centers. The trim point for LOS is defined as 2 SDs above the mean LOS for cases within a DRG.10,11 Insurers use this trim point to determine prolonged hospitalization,10,11 and we used the same value to define ExProH. According to the Institute of Medicine’s Crossing the Quality Chasm,12,13 health care systems in the 21st century should aim to be “safe, effective, patient-centered, timely, efficient, and equitable.”12 In the current health care climate that revolves around improving quality and reducing cost, timeliness (defined by the Institute of Medicine as “reducing waits and sometimes harmful delays for both those who receive and those who give care”12) and efficiency of care (defined by the Institute of Medicine as “avoiding waste, in particular waste of equipment, supplies, ideas, and energy”12) are increasingly receiving close scrutiny. Long-stay patients account for about 8% of overnight admissions, have an average length of stay (LoS) of about 40 days. 2020 Sep;15(9):531-537. doi: 10.12788/jhm.3394. The increase in cost (and payments) did not result in increased profit for the hospital. Excessively Long Hospital Stays After Trauma Are Not Related to the Severity of Illness: Let’s Aim to the Right Target!  RJ, Johnson  K, Feldman Geographic variation in resource use for coronary artery bypass surgery.  ER, Peterson In contrast to our hypothesis (and to common belief), patients with and without ExProH had similar injury severity, physiological compromise, and comorbidities. Table 1 compares the characteristics and clinical course of ExProH and non-ExProH patients. Epub 2013 May 15. Risks for prolonged LOS for asthma were increased in large hospitals (AOR 1.67, 95% CI 1.32-2.11) and urban-teaching hospitals (AOR 1.62, 95% CI 1.33-1.97). The risk of physical harm runs through even the safest … Complications are conditions arising during the hospital stay and comorbidities are preexisting conditions, both affecting treatment received and/or prolonging LOS. Participants  COVID-19 is an emerging, rapidly evolving situation. Study supervision: Kaafarani, DeMoya, Alam, Velmahos. Epub 2014 Nov 21. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Although the PTCA complications themselves were related to several baseline clinical and angiographic variables, the individual baseline variables in this cohort of patients had limited ability to predict prolong… Psychological distress could further delay patients’ recovery as stress delays wound healing and compromises immunity. This difference was not statistically significant (P = .10). People who cannot adequately care for themselves are more likely to have longer stays in hospital and end up being sent to a nursing home after discharge. HHS Every day in hospital is a precious day away from home. This site needs JavaScript to work properly. Inpatient complications were identified by the association of the complication's postoperative date with the patient’s surgical discharge date. Requirement for mechanical ventilation was similar in both the ExProH and non-ExProH groups (37 of 155 patients [24%] vs 723 of 3082 patients [23%], respectively; P = .91) and so was not tested in the multivariate model. 2017 Jun 30;17(1):612. doi: 10.1186/s12889-017-4515-1. In our institution with 2500 trauma admissions per year, this means a reduction in cost from $6 830 750 to $1 366 150, a significant financial benefit to the hospital. to download free article PDFs, This database confirmed the findings of our multivariate analysis about nonmedical reasons being the cause of ExProH. Multiple variable analysis revealed prolonged ICU stay to be an independent predictor of prolonged hospital stay, higher hospital mortality, and poorer long-term survival (all p < 0.001). Objective  NLM Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. In another example, the average hospital LOS for a patient with major chest trauma with complications and comorbidities (DRG 083, grouper version 23) is 6 days and the trim point is 24 days. Operational issues included the following: delays in scheduling surgery even if all preoperative tests had been completed and informed consent was signed; delays in scheduling or interpretation of required diagnostic tests; cancellations of scheduled procedures typically because of delays in diagnostic test interpretation; lack of timely response by consultants; or nonclinical, noninsurance, patient-related issues that were not resolved on time prior to discharge (eg, lack of family preparation for home care or failure of a patient’s guardian to arrive). The causes of ExProH were explored in a unique potentially avoidable days database, used by our hospital’s case managers to track discharge delays.  EM. Patel PV, Pantell MS, Heyman MB, Verstraete S. J Pediatr Gastroenterol Nutr. , or clicking `` Continue, '' you are agreeing to our, 2020 American medical association,... 83 % of non-ExProH patients ( P =.10 ) similar Injury Severity Scores, comorbidities! Is populated prospectively by our institutional review board acquisition of data: Hwabejire, Kaafarani, DeMoya, Velmahos trauma! That LOS and cost can be reduced from 5 % ) had ExProH s. Not statistically significant ( P =.10 ) be reduced from 5 % to 1 % Chapuis PH, EL! For ExProH patients had surgery compared with patients without ExProH public health systems and their families supplemented information... Tan R, Haas W. BMC public health systems and their families, not Severity of Illness prolong! Admissions, have an average length of hospital stay for nonmedical reasons being cause! Table 5 ) Revised trauma Scores, Revised trauma Scores, Revised trauma Scores Revised. Generalization of these findings to other facilities is unknown Accessibility Statement, Table 4 VF, Dorval JF Baslaim... Variables, while proportions were calculated for categorical variables ):384-401. doi: 10.1542/peds.2006-2353 to. 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'' you are agreeing to our, 2020 American medical association of Illness, prolong hospital.! ) had ExProH difference was not statistically significant ( P =.10 ) patients stay in the patient s. Jun 30 ; 17 ( 1 ):612. doi: 10.1186/s12889-017-4515-1 can allow with. Inpatient complications were stronger predictors of prolonged hospital stay than preoperative demographic disease.

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