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Prolonged length of stay in hospitalized internal medicine patients

Published:November 09, 2015DOI:https://doi.org/10.1016/j.ejim.2015.10.011

      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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