Abstract
BackgroundMost National Health Service (NHS) hospital bed occupants are older patients because of their frequent admissions and prolonged length of stay (LOS). We evaluated demographic and clinical factors as predictors of LOS in a single NHS Trust and derived an equation to estimate LOS.MethodsStepwise logistic and linear regressions were used to predict prolonged LOS (upper-quintile LOS > 17 days) and LOS respectively, from demographic factors and acute and pre-existing conditions.ResultsOf 374 (men:women = 127:247) admitted patients (20% to orthogeriatric, 69% to general medical and 11% to surgical wards), median age of 85 years (IQR = 78–90), 77 had acute first hip fracture; 297 had previous hip fracture (median time since previous fracture = 2.4 years) and 21 (7.1%) had recurrent hip fracture, with median time since first fracture = 2.4 years. Median LOS was 6.5 days (IQR = 1.8–14.8), and 38 (10.2%) died after 4.8 days (IQR = 1.6–14.3). Prolonged LOS was associated with discharge to places other than usual residence: OR = 3.1 (95% CI 1.7–5.7), acute stroke: OR = 10.1 (3.7–26.7), acute first hip fractures: OR = 6.8 (3.1–14.8), recurrent hip fractures: OR = 9.5 (3.2–28.7), urinary tract infection/pneumonia: OR = 4.0 (2.1–8.0), other acute fractures: OR = 9.8 (3.0–32.3) and malignancy: OR = 15.0 (3.1–71.8). Predictive equation showed estimated LOS was 11.6 days for discharge to places other than usual residence, 15 days for pre-existing or acute stroke, 9–14 days for acute and recurrent hip fractures, infections, other acute fractures and malignancy; these factors together explained 32% of variability in LOS.ConclusionsA useful estimate of outcome and LOS can be made by constructing a predictive equation from information on hospital admission, to provide evidence-based guidance for resource requirements and discharge planning.
Highlights
The population of older people in the UK is expanding
Hip fracture in older patients is principally a marker of age-related frailty and co-existing morbidity, polypharmacy, cognitive decline and visual impairment, all of which contribute to falls and consequent fractures [6,7,8,9]
About 2.7 million hospital bed days were found to be occupied by older patients who no longer needed acute treatment, equating to an excess of estimated gross annual cost to the National Health Service (NHS) of approximately £820 million [10]
Summary
The population of older people in the UK is expanding. Among the 65.6 million population in 2016, there were 18% aged 65 years or over and 2.4% 85 years or over [1]. The majority of National Health Service (NHS) hospital bed occupants are older patients because of their frequent admissions and prolonged length of stay (LOS), exerting high burden on healthcare system. About 2.7 million hospital bed days were found to be occupied by older patients who no longer needed acute treatment, equating to an excess of estimated gross annual cost to the NHS of approximately £820 million [10]. Prolonged LOS increases adverse health consequences to patients including sarcopenia [10] and increased risk of nosocomial infections [11,12,13]. These problems tend to perpetuate a vicious cycle of delay to discharge. We evaluated demographic and clinical factors as predictors of LOS in older patients in medical wards of a single NHS Trust and derived an equation to estimate LOS from these factors
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