Abstract
BackgroundFailure in the timely follow-up of test results has been widely documented, contributing to delayed medical care. Yet, the impact of delay in reviewing test results on hospital length of stay (LOS) has not been studied. We examine the relationship between laboratory tests review time and hospital LOS.MethodsA retrospective cohort study of inpatients admitted to a metropolitan teaching hospital in Sydney, Australia, between 2011 and 2012 (n = 5804). Generalized linear models were developed to examine the relationship between hospital LOS and cumulative clinician read time (CRT), defined as the time taken by clinicians to review laboratory test results performed during an inpatient stay after they were reported in the computerized test reporting system. The models were adjusted for patients’ age, sex, and disease severity (measured by the Charlson Comorbidity index), the number of test panels performed, the number of unreviewed tests pre-discharge, and the cumulative laboratory turnaround time (LTAT) of tests performed during an inpatient stay.ResultsCumulative CRT is significantly associated with prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of prolonged LOS by 13.2% (p < 0.0001). Restricting the analysis to tests with abnormal results strengthened the relationship between cumulative CRT and prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of delayed discharge by 33.6% (p < 0.0001). Increasing age, disease severity and total number of tests were also significantly associated with prolonged LOS. Increasing number of unreviewed tests was negatively associated with prolonged LOS.ConclusionsReducing unnecessary hospital LOS has become a critical health policy goal as healthcare costs escalate. Preventing delay in reviewing test results represents an important opportunity to address potentially avoidable hospital stays and unnecessary resource utilization.
Highlights
Failure in the timely follow-up of test results has been widely documented, contributing to delayed medical care
Cumulative clinician read time (CRT) is significantly associated with prolonged length of stay (LOS), with each day of delay in reviewing test results increasing the likelihood of prolonged hospital stay by 13.2% (p < 0.0001)
Increasing age, disease severity and total number of tests were significantly associated with prolonged LOS (Table 2a)
Summary
Failure in the timely follow-up of test results has been widely documented, contributing to delayed medical care. Substantial research and policy efforts have been directed at reducing unnecessary hospital length of stay (LOS), a key indicator for inpatient resource use. Research into the determinants of hospital length of stay (LOS) has identified a range of patient characteristics and clinical predictors contributing to prolonged LOS [2]. These include age, sex, disease severity, presenting conditions and complications [3,4,5,6,7,8,9,10]. Patients may experience prolonged hospitalizations due to delays in accessing care [11] Identifying these modifiable factors can provide important opportunities for interventions
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