Highlights
- •We analyzed the characteristics of patients with prolonged LOS in internal medicine.
- •3.2% of patients had a prolonged LOS and accounted for 17.4% of total inpatient days.
- •Prolonged LOS patients were more likely to be discharged to a postacute-care facility.
Abstract
Background
Targeting patients with prolonged hospitalizations may represent an effective strategy
for reducing average hospital length of stay (LOS). Objective: We sought to characterize
predictors of prolonged hospitalization among internal medicine patients in an effort
to guide future improvement efforts.
Design
We conducted a retrospective cohort study using administrative data of internal medicine
patients from all hospitals of the Spanish Public Health Service between January 1st,
2005 and December 31st, 2013. Multivariable logistic regression was performed to assess
the association between sociodemographic and clinical variables and prolonged LOS,
defined as >30 days.
Key results
Of 5,275,139 discharges, 166,470 (3.2%) had a prolonged LOS. Prolonged hospitalizations
accounted for 17.4% of total inpatient days and contributed 0.5 days to an average LOS of 9.8 days during the study period. Prolonged hospitalizations were associated with younger
age (odds ratio [OR]: 0.97 per 10-year increase in age, 95% confidence interval [CI]:
0.96–0.98) and male gender (OR 0.88 IC95% 0.87–0.89). Compared to patients without
prolonged LOS, prolonged LOS patients were more likely to require a palliative care
consult (OR: 2.48, 95% CI: 2.39–2.58), surgery (OR: 6.9 95% CI: 6.8–7.0); and be discharged
to a post-acute-care facility (OR: 2.91, 95% CI: 2.86–2.95).
Conclusions
Prolonged hospitalizations in a small proportion of patients were an important contributor
to overall LOS and particularly affected complex hospital stays who were not discharged
home.
Keywords
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References
- Benchmarking and reducing length of stay in Dutch hospitals.BMC Health Serv. Res. 2008; 24: 8-220
- Adverse health outcomes after discharge from the emergency department—incidence and risk factors in a veteran population.J. Gen. Intern. Med. 2007; 22: 1527-1531
- Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool.PLoS One. 2014; 9e110135
- Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients.Geriatr. Gerontol. Int. 2015; 9https://doi.org/10.1111/ggi.12471
- Pressure on hospitals has led to worse care for older patients.BMJ. 2012; 345 (e6137)
- The epidemiology of delays in a teaching hospital. The development and use of a tool that detects unnecessary hospital days.Med. Care. 1989; 27: 112-129
- A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service.J. Gen. Intern. Med. 2005; 20: 108-115
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J. Chronic Dis. 1987; 40: 373-383
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J. Clin. Epidemiol. 1992; 45: 613-619
- Factors influencing hospital high length of stay outliers.BMC Health Serv. Res. 2012; 12: 265
- Understanding predictors of prolonged hospitalizations among general medicine patients: a guide and preliminary analysis.J. Hosp. Med. 2015; (Jun 30)https://doi.org/10.1002/jhm.2414
- Adverse in-hospital events are associated with increased in-hospital mortality and length of stay in patients with or at risk of acute respiratory distress syndrome.Mayo Clin. Proc. 2015; 90: 321-328
- Nonmedical factors associated with prolonged hospital length of stay in an urban homebound population.J. Hosp. Med. 2012; 7: 73-78
- Patient and hospitalization characteristics associated with increased postacute care facility discharges from US hospitals.Med. Care. 2015; 53: 492-500
Article info
Publication history
Published online: November 09, 2015
Accepted:
October 16,
2015
Received in revised form:
October 15,
2015
Received:
August 11,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
