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At least 19 recordsLinked to original sources
PubMed1990

Hospital stay length as an effect modifier of other risk factors for nosocomial infection.

This paper addresses the problem of hospital stay length as a risk factor for nosocomial infection and as a modifier of the effect of other risk factors for hospital infection. Patients were selected form two cross-sectional studies done in two different seasons of 1986. Risk of infection rose fairly steadily as hospital stay length increased (correlation coefficient: 0.83, p less than 0.01). Several risk factors (operation, underlying disease, and age) were analyzed on the basis of 1) raw data and 2) data stratified by length of stay. The results showed that hospital stay length is a strong modifier of the remaining risk factors, generally reducing, their effect on the development of hospital infection as length of stay increases.

Adolescent↗
PubMed2003

Length of stay, conditional length of stay, and prolonged stay in pediatric asthma.

OBJECTIVE: To understand differences in length of stay for asthma patients between New York State and Pennsylvania across children's and general hospitals in order to better guide policy. DATA SOURCES/STUDY SETTING: All pediatric admissions for asthma in the states of Pennsylvania and New York using claims data obtained from each state for the years 1996-1998, n = 38,310. STUDY DESIGN: A retrospective cohort design to model length of stay (LOS), the probability of prolonged stay, conditional length of stay (CLOS or the LOS after stay is prolonged), and the probability of readmission, controlling for patient factors, state, location and hospital type. ANALYTIC METHODS: Logit models were used to estimate the probability of prolonged stay and readmission. The LOS and the CLOS were estimated with Cox regression. Model variables included comorbidities, income, race, distance from hospital, and insurance type. Prolonged stay was based on a Hollander-Proschan "New-Worse-Than-Used" test, corresponding to a three-day stay. PRINCIPAL FINDINGS: The LOS was longer in New York than Pennsylvania, and the probabilities of prolonged stay and readmission were much higher in New York than Pennsylvania. However, once an admission was prolonged, there were no differences in CLOS between states (when readmissions were not added to the LOS calculation). In both states, children's hospitals and general hospitals had similar adjusted LOS. CONCLUSIONS: Management of asthma appears more efficient in Pennsylvania than New York: Less severe patients are discharged faster in Pennsylvania than New York; once discharged, patients are less likely to be readmitted in Pennsylvania than New York. However, once a stay is prolonged, there is little difference between New York and Pennsylvania, suggesting medical care for severely ill patients is similar across states. Differences between children's and general hospitals were small as compared to differences between states. We conclude that policy initiatives in New York, and other states, should focus their efforts on improving the care provided to less severe patients in order to help reduce overall length of stay.

Adolescent↗
PubMed2004

Length stay, discharge disposition, and hospital charge predictors.

THIS STUDY EXPLORED the effect of patient, clinical, and treatment factors on length of stay (LOS), discharge disposition, and total acute care hospital charges for older adults undergoing elective total hip arthroplasty or total knee arthroplasty. A CAUSATIVE RETROSPECTIVE DESIGN was used, and data analysis included descriptive statistics, multiple regression, and logistic regression. SIGNIFICANT DIFFERENCES in predictor variables (ie, age, gender, living arrangement, comorbidities, postoperative complications) were found between patients who were discharged to home and those who were discharged to another facility. Only postoperative complications contributed significantly to LOS. Total surgical time and postoperative complications contributed significantly to hospital charges.

Aftercare↗
PubMed1998

[Substantiation of patients' length stay in hospital after acute myocardial infarct].

AIM: To study and validate the duration of optimal hospital stay for postmyocardial infarction patients and to specify indications for their discharge. MATERIALS AND METHODS: The trial enrolled 187 patients with large- and small-focal acute myocardial infarction. The patients were divided into two groups by different speed of activization and hospital stay. RESULTS: There were no significant differences between the groups with different duration of hospital stay by working ability and invalidism. Temporary disability in patients who have undergone standard rehabilitation was longer than in patients on the shorter-program rehabilitation. Performance of exercise tests on day 14 distinguished patients with a favourable long-term prognosis who were candidates for shorter rehabilitation program. CONCLUSION: The program of quicker rehabilitation (a two-times decrease in the hospital stay) can be applied to patients with uncomplicated myocardial infarction without damage to their health.

Adult↗
PubMed1986

[Length of stay and length of work incapacity in patients with Type I diabetes. Effects of a diabetes treatment and education program].

Objective data on duration of hospital stay and of incapacity to work were collected for 137 type I diabetics who had taken part in a structured diabetes treatment and training scheme. Before the training period the average hospital stay had been 0.76 per patient per year, duration per stay 21 days, number of episodes of work incapacity 1.6 per patient per year, duration of incapacity 23.6 days. For a subgroup of patients (62) the influence of the training programme could be demonstrated: hospital stay fell to 0.49 per patient per year, duration per stay to 12.0 days, number of incapacity episodes to 1.4 per patient per year, and the days lost from work to 12.1 per patient per year.

Absenteeism↗
PubMed2003

Emergency department length of stay independently predicts excess inpatient length of stay.

OBJECTIVE: To examine the association between emergency department length of stay (EDLOS) and inpatient length of stay (IPLOS). DESIGN: Retrospective review of presentations and admissions data. SETTING: Three metropolitan hospitals in Melbourne, 1 July 2000 to 30 June 2001. MAIN OUTCOME MEASURES: Mean IPLOS for four categories of EDLOS (</= 4 hours, 4-8 hours, 8-12 hours, >12 hours); excess IPLOS, defined as IPLOS exceeding state average length of stay; odds ratios for excess IPLOS adjusted for age, sex and time of presentation. RESULTS: 17 954 admissions were included. Mean IPLOS for the four categories of EDLOS were </= 4 hours, 3.73 days; 4-8 hours, 5.65 days; 8-12 hours, 6.60 days; > 12 hours, 7.20 days (P < 0.001). The corresponding excess IPLOS were 0.39, 1.30, 1.96 and 2.35 days (P < 0.001). Compared with EDLOS 4-8 hours, odds ratios (95% CIs) for excess IPLOS associated with the other three categories of EDLOS were </= 4 hour, 0.68 (0.63-0.74); 8-12 hours, 1.20 (1.10-1.30); and > 12 hours, 1.49 (1.36-1.63), after adjusting for elderly status, sex and time of ED presentation. CONCLUSION: EDLOS correlates strongly with IPLOS, and predicts whether IPLOS exceeds the state benchmark for the relevant diagnosis-related group, independently of elderly status, sex and time of presentation to ED. Strategies to reduce EDLOS (including countering access block) may significantly reduce healthcare expenditure and patient morbidity.

Aged↗
PubMed2006

Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

OBJECTIVE: To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. DATA SOURCES: Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. STUDY DESIGN: Data on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999, 2000, and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals. PRINCIPAL FINDINGS: There is significantly (p<.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals. CONCLUSION: Physicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.

Decision Making↗
PubMed2006

Impact of postpartum hospital-stay legislation on newborn length of stay, readmission, and mortality in California.

OBJECTIVES: The objectives of this study were to examine the impact of postpartum hospital-stay legislation on newborns' length of stay, neonatal readmissions, and 1-year mortality in California, and whether this legislation had differential impacts by demographics and complications during delivery or pregnancy. METHODOLOGY: This study used linked birth certificates, death certificates and hospital discharge records for all full-term, normal birth weight, and singleton-birth newborns during 1991-2000 in California (n = 662,753). Interrupted time-series analyses were used to examine changes in newborns' length of stay and outcomes after 1 year, 2 years, and 3 years since the passage of postpartum laws. Multivariate linear and logistic regressions were estimated separately by maternal characteristics (race, education, age, and partity), delivery type, and complications during pregnancy or delivery. RESULTS: Length of stay increased by 9.5, 12, and 14 hours in years 1, 2, and 3, respectively, after the passage of the law. Increases were larger for newborns of white mothers, more educated mothers, mothers >35 years of age, primaparous mothers, cesarean deliveries, and Medicaid recipients, but there were no differences by pregnancy or delivery complications. The odds of neonatal readmission declined by 9.3%, 11.8%, and 19.7% in years 1, 2 and 3 after the law, respectively. The odds of infection-related readmissions declined by 21.5% and 30.3% in years 2 and 3, respectively. The odds of jaundice-related readmissions increased by 7% in year 1. There was no significant change in either the odds of readmission due to respiratory problems or the odds of 1-year mortality in the postlaw years. Demographic differences in the impact of the law on readmissions and mortality could not be detected because of lack of statistical power. CONCLUSIONS: Postpartum length of stay legislation was associated with increased length of stay among all births in California, with significant variation in the law's impact across demographic groups. After the law's passage, there was a significant decline in neonatal readmissions but not in 1-year mortality.

California↗
PubMed1995

Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario.

BACKGROUND: A multicenter population-based study was conducted to develop and validate a risk index for mortality, intensive care unit (ICU) length of stay, and postoperative length of stay after cardiac surgery. METHODS AND RESULTS: Data were collected from 13,098 patients undergoing cardiac surgery between April 1, 1991, and March 31, 1993, at all nine adult cardiac surgery institutions in Ontario, Canada. A six-variable risk index (age, sex, left ventricular function, type of surgery, urgency of surgery, and repeat operation) was developed using logistic regression analysis to predict in-hospital mortality, ICU stay in days, and postoperative stay in days after cardiac surgery in a derivation set of 6213 patients who had cardiac surgery during fiscal year 1991 (April 1, 1991, to March 31, 1992). The index predicted mortality, prolonged ICU stay (> or = 6 days), and prolonged postoperative length of stay (> or = 17 days) after cardiac surgery with areas under the receiver-operating characteristic (ROC) curve of 0.75, 0.66, and 0.69, respectively, in an independent validation set of 6885 patients who had cardiac surgery during fiscal year 1992 (April 1, 1992, to March 31, 1993). Increasing risk scores were associated with greater mortality rates and longer ICU and postoperative stays at all nine institutions. CONCLUSIONS: Mortality, ICU length of stay, and postoperative length of stay after cardiac surgery can be predicted using a simple six-variable risk index. The index has potential application as a risk stratification tool for comparing patient outcomes and resource use among different hospitals and surgeons.

Adult↗
PubMed2001

Reasons for increased postnatal length of stay & women's perceptions of length of stay.

A quality improvement project was conducted by a major maternity provider (3000 births per year) in the western suburbs of Melbourne. The first part of the project explored the reasons for increased length of stay (LOS), beyond the average timeframe for women receiving postnatal care. The perceptions of 100 women on their length of stay was also measured in the second part of the project. Two information audits were conducted to explore reasons for increased LOS. These reasons were varied, and by the time of the second audit, there was a demonstrated reduction in LOS. A Length of Stay Questionnaire was used to investigate women's perceptions of their LOS on discharge from hospital, and by telephone follow-up 14 days post-discharge. Perceptions varied between women and related to issues such as individual health complications, models of care, postnatal education, and degree of support at home. This project has implications for postnatal midwifery care in relation to discharge planning and women's expectations of care following birth.

Female↗
PubMed2005

A robustified modeling approach to analyze pediatric length of stay.

PURPOSE: Length of stay (LOS) is an important measure of the cost of pediatric hospitalizations, but the guidelines developed so far are not rigorously evidence-based. This study demonstrates a robust gamma mixed regression approach to analyze the positively skewed LOS variable, which has implications for future studies of pediatric health care management. METHODS: The robustified approach is applied to analyze hospital discharge data on childhood gastroenteritis in Western Australia (n=514). The model accounts for demographic characteristics and co-morbidities of the patients, as well as the dependency of LOS outcomes nested within the 58 hospitals in the State. The method is compared with the standard linear mixed regression with trimming of extreme observations. RESULTS: For the empirical application, the linear mixed regression results are sensitive to the magnitude of trimming. The identified significant factors from the robust regression model, namely infection, failure to thrive, and iron deficiency anemia are resistant to high-LOS outliers. CONCLUSIONS: Robust gamma mixed regression appears to be a suitable alternative to analyze the clustered and positively skewed pediatric LOS, without transforming and trimming the data arbitrarily.

Child, Hospitalized↗
PubMed1987

[Factors related to length of hospitalization of elderly patients during short stay].

Length of stay of elderly patients in hospitals can be subdivised into a medical stay followed by a social stay. The average length of stay of 2134 patients aged 75 and over, admitted to 23 medical or geriatric acute wards in Aquitaine, was 13.6 days; 18% of the patients experienced a social stay of at least one day. The mean social stay was almost null (1 day) when the patient returned home, but could reach 5 days when he was discharged to a long term care facility. The kind of hospital, domicile in a rural area, the social network, and the grounds for hospitalization were significantly related to the total length of stay, but explained only 5% of variance if diagnosis was not taken into account. This percentage rose to 29% in the group with "bronchitis" as a main diagnosis. The length of social stay was related to the grounds for hospitalization, but also to recent family modifications; it did not depend on the kind of hospital. These results suggest a lack of accessibility to nursing-homes, following acute hospitalization.

Aged↗
PubMed1993

Differences between long-stay and short-stay inpatients and estimation of length of stay. A prospective study.

To find possible differences between new long-stay inpatients and patients with shorter lengths of stay, a prospective study of 340 inpatients in the 4th week of hospitalization was carried out. The new long-stay patients differed from the others in diagnoses, symptoms, duration of prior hospitalizations, and socio-demographic data. On the basis of the data assessed in the 4th week of hospitalization, we tried not only to predict future new long-stay patients, but also to estimate the length of stay for all 340 patients. A time-function model was employed with length of stay as a continuous variable, and this resulted in correct allocation to the quartiles in 38-48% of the cases. Six variables proved to be important for estimating length of stay: emotional withdrawal, blunted affect, mannerisms, duration of previous hospitalizations, living conditions (prior to admission), and marital status.

Adult↗