Average Length Of Stay For Patients Research Articles

Reduction in Average Length-of-Stay in Emergency Department of a Low-Income Country's Cancer Hospital.

Prolonged length of stay (LOS) in emergency departments (ED) is a widespread problem in every hospital around the globe. Multiple factors cause it and can have a negative impact on the quality of care provided to the patients and the patient satisfaction rates. This project aimed to ensure that the average LOS of patients in a tertiary care cancer hospital stays below 3 hours. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) approach was followed. The average LOS was 166 minutes before implementing interventions. The two primary reasons for the increased length of stay were delays secondary to physician assessment and diagnostic lab reports. Strategies were defined to control these factors, which helped reduce the average length of stay to 142 minutes, a 30% reduction. A process improvement model similar to this project is recommended to enhance the quality of hospital services. It will provide valuable insights into the process flow and assist in gathering precise data on the various steps involved. The data collected can then be analyzed to identify potential causes and make informed decisions that can significantly improve hospital processes.

PO-03-153 POST-OPERATIVE ATRIAL FIBRILLATION STANDARIZATION OF CARE THROUGH CLINICAL CARE PATHWAYS FOR CARDIAC SURGICAL PATIENTS

Post-operative atrial fibrillation (POAF) occurs commonly in cardiac surgical patients up to 55% of the time leading to an increase risk of thromboembolic events, stroke, renal and respiratory failure, and an increase in all-cause 30-day and 6-month mortality. Standardization of care through guideline-directed clinical pathways may decrease occurrence of POAF and morbidity associated with it in the post-operative period. A multidisciplinary team including cardiac electrophysiologist, cardiac surgeons, and pulmonary critical care physicians developed a guideline-directed clinical AF pathway for patients with POAF. Patients were consecutively enrolled with the use of the AF pathway. The data of interest has been collected in a REDCap database. A retrospective review was performed of 327 cardiac surgery patients in 2020 as well as 301 cardiac surgery patients in 2021 after the POAF pathway implementation. Baseline characteristics of both groups in addition to the length of stay (LOS), hospitalization from admit to discharge, readmissions recurrent of AF post discharge were collected for both cohorts of patients. Baseline characteristics of patients that utilized the POAF pathway compared to ones in the retrospective review prior to implementation of the POAF pathway demonstrated no no statistical difference in cardiovascular comorbidities including baseline existence of hypertension, diabetes, left atrial size, age and obesity. There was however a significant reduction in LOS in patients that utilized the POAF pathway. The average LOS for patients that were included in the POAF pathway was reduced by 8 days (6 to 14 days) with a p-value of < 0.0001 compared to the conventional cohort. This resulted in an estimated > 2400 hospital days avoided which equates to approximately $1.36M total cost savings based on the calendar year 2021 estimated cost per opportunity day. Additionally, there is was a decrease in hospital readmissions, occurrence of AF during hospitalization and post discharge. POAF clinical pathway utilization for cardiac surgical patients significantly reduced LOS and reduced hospital readmissions for AF as well as recurrence of AF during and after hospitalizations therefore improving overall cardiac surgical outcomes.

Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay and Mortality Among Immobile Hemorrhagic Stroke Patients Younger Than 50 Years.

Objective: The burden of comorbidity among young patients with hemorrhagic stroke is high. This study examines the effect of comorbidity on the length of stay (LoS) and mortality among immobile hemorrhagic stroke patients younger than 50 years.Materials and Methods: A retrospective post-hoc analysis study design was used. A total of 767 younger adults (mean age 41.64 ± 8.16 years) hospitalized for hemorrhagic stroke between November 2015 and July 2017 were evaluated. All-cause mortality was recorded for 90 days after admission regardless of whether death occurred before or after discharge. Comorbidity was assessed using the Charlson Comorbidity Index (CCI), categorized as low (0–1) and high (≥2). A multiple linear regression model was applied to examine the association between CCI and LoS. Survival was evaluated with Kaplan–Meier and Cox regression analyses.Results: The mean CCI of all patients was 1.25 (SD ± 0.79) and median was 1.0 (IQR 1, 1). The average LoS for patients with a low CCI was 17.73 (± 11.59) days compared with 19.49 (± 15.21) days in those with a high CCI (p = 0.142). The mortality rate was 6.0% (12.10% for high CCI vs. 4.82% for low CCI, p = 0.002). After controlling for confounders, high CCI was not associated with longer LoS (regression coefficient 0.825, 95% CI −1.155 to 2.805; p = 0.413), whereas high CCI was associated with greater likelihood of death than a low CCI (hazard ratio 3.417, 95% CI 1.626 to 7.180; p = 0.001).Conclusions: High global comorbidity was associated with increased short-term mortality but not with LoS. Measures to manage comorbidities aimed at reducing negative clinical impacts of stroke among younger adults are warranted.

Luaran Terapi Berdasarkan Jenis Pemberian Analgetik pada Pasien Pasca Operasi Ortopedi

Postoperative pain was suffered by 80% of the total patients. One of the many surgical procedures performed is orthopedics. Ketorolac and fentanyl are often used for postoperative orthopedic pain. Appropriate postoperative pain management with adequate analgesic administration will accelerate pain reduction and shorten the patient's hospital stay. This study aims to determine the difference in the effect of continuous fentanyl and intravenous ketorolac on pain targets achievement and Length of Stay (LOS) of patients after orthopedic surgery. This study is a prospective cohort study, involving inpatients after orthopedic surgery in Dr. Sardjito Yogyakarta in July-October 2019. The independent variable is continuous fentanyl and intravenous ketorolac, while the dependent variable is the achievement of pain targets and LOS. The analysis was conducted by Fisher's exact test, Mann Whitney's test, and multivariate analysis to determine the dominance of variables on the research outcomes. There were 59 patients after orthopedic surgery in this study. A total of 34 patients in the continuous fentanyil group and 25 patients in the intravenous ketorolac group. There was no difference in the effect of continuous fentanyl administration and intravenous ketorolac on pain targets achievement (P = 0.711), while there were differences in the effect of continuous fentanyl administration and intravenous ketorolac on the average LOS of patients in the hospital (P = 0,000). Continuous fentanyl and intravenous ketorolac can both produce the achievement of adequate postoperative orthopedic pain targets, but the mean LOS becomes shorter in patients with intravenous ketorolac.

Impact of Implementation of Additional Endoscopy List on Hospital Inpatient Length of Stay

Extended average length of stay (ALOS) leads to increased hospital expenditure. Prioritization of emergency endoscopies over routine elective procedures results in delay and adds on to patients’ ALOS at tertiary hospitals. The gastroenterology department of Fiona Stanley Hospital aimed a service improvement project to shorten the ALOS of inpatients by implementing a new quarantined booking and procedural system allowing elective access to endoscopic procedures. An additional endoscopy list (quarantine list) was implemented with full participation of the stakeholders once a month for a 3-month trial period for inpatients by moving resources from a nearby satellite service. A comparison of the ALOS of patients before and after realizing the preceding intervention was carried out using the time and date information obtained from the theater management and the e-referral system of all routine inpatients with a valid e-referral for gastroscopy or colonoscopy. Upper gastrointestinal endoscopies comprised over two-thirds of the inpatient scopes performed. The ALOS and average time spent for referral improved by 1.09 and 1.97 days, respectively. The ALOS reduced by over 1 day, and improvement was noticed in the prereferral segment. Postreferral efficiency did not improve, and undertaking further analysis to determine the root causes for the continual delay is recommended.

Obstetric Patients with Repetitious Hospital Location Transfers Have Prolonged Stays.

There is a general belief that the workflow of surrounding location transfers between locations documented in electronic health record (EHR) during hospitalization is associated with a patient's length of stay (LOS). However, this belief has had little formal investigation in a data-driven manner. Location transfers in patients' hospitalization are hypothesized to be related to LOS. The objective of this study is to assess this relationship, using data derived from the EHR system of a large hospital system, with a focus on the obstetric setting - a clinical environment that exhibits wide swing in resource utilization. We designed a data-driven framework to infer patterns of location transfers and developed a zero-truncated negative binomial model, adjusting for demographics and billed diagnoses, to learn the association between patterns of location transfers and LOS. Indicative factors found to be of indicative of location transfer patterns were further investigated via their odds ratios, Pearson Correlation Coefficients, and Chi-squared test. We evaluated our approach with two years of data on from 5,774 obstetric inpatient encounters from the EHR system of Northwestern Memorial Hospital. The results indicated that the average LOS for patients with patterns of repetitious location transfers (RLTs) was 4.25 days (95% confidence interval [4.02, 4.47]) longer than patients with no RLT. This difference reduced to 3.62 days (95% confidence interval [3.61, 3.64]) after adjusting for age, race and billed diagnoses. We further discovered 21 indicative factors of RLT (statistically significant with a significance level of 0.05), in the form of billed diagnosis codes, each of which exhibited an odds ratio larger than 4. This study suggests that RLT patterns are associated with a prolonged LOS in the obstetric setting. As such, healthcare organizations may need to pay more attention to patients with RLTs to refine location transfers workflow and to boost efficiency in obstetric care.

Blood Glucose Control in Noncritically Ill Patients Is Associated With a Decreased Length of Stay, Readmission Rate, and Hospital Mortality.

Multiple studies have shown that hyperglycemia correlates with mortality and morbidity in critically ill patients. This has not been demonstrated in noncritically hospitalized patients. The primary objective of this study was to determine whether glycemic control shortens the length of stay (LOS). Secondary objectives included assessing readmissions, in-hospital mortality, and rates of hypoglycemia. A retrospective review of hospitalized patients admitted between 2008 and 2012 with fingerstick blood sugar (FSBS) was performed. Patients were divided into two groups: "controlled" FSBS (≥80% of FSBS were <180 mg/dL) and "uncontrolled" FSBS (<80% of FSBS were <180 mg/dL). The average LOS (ALOS) in days, in-hospital mortality, readmission rates, and rates of hypoglycemia was compared. A total of 32,851 patient records were reviewed. ALOS for patients with controlled and uncontrolled FSBS was 5.86 and 6.17 days, respectively (p < .0001). Readmission within 30 days and hospital mortality were significantly lower in patients with controlled FSBS (p = .0000, .00001), whereas rates of hypoglycemia were significantly higher in the uncontrolled group (p = .00000). Glycemic control was associated with decreased LOS, hospital mortality, and 30-day readmission rate in noncritically ill patients regardless of the presence or absence of diabetes.

Use of a Publicly Available Database to Determine the Impact of Diabetes on Length of Hospital Stay for Elective Orthopedic Procedures in California.

In California, 1 in 3 hospital beds are occupied by adults with diabetes. The aim of this study was to examine whether diabetes impacts length of stay (LOS) following common elective orthopedic procedures compared to nondiabetic individuals, and also the performance of hospitals across California for these procedures. Using the Public Use California Patient Discharge Data Files for 2010-2012, the authors examined LOS for elective discharges for hip, spine, or knee surgery (n = 318,861) from the total population of all discharges (n = 11,476,073) for 309 hospitals across California. In all, 16% of discharges had a codiagnosis of diabetes. Unadjusted average LOS was 3.11 days without and 3.40 days with diabetes (mean difference 0.29 [95% confidence interval (0.27, 0.31) days, P < 0.01]). After adjusting for covariates, diabetes no longer resulted in a significant difference in LOS. However, the presence of common comorbidities did significantly impact LOS. Average LOS for patients with diabetes also varied widely by hospital, ranging between -50% and +100% of the mean LOS for all hospitals. Diabetes does not prolong LOS after orthopedic procedures unless comorbidities are present. Nevertheless, across California there is significant variation in LOS between individual hospitals, which may inform the decision-making process for prospective patients and payers.

Abstract 205: Minimizing Post Procedural Bleeding Complications - A Quality Improvement Initiative

Objectives: The primary purpose of this study is to implement the National Cardiovascular Data Registry (NCDR) CathPCI bleeding risk score pre-procedurally, in order to identify the patients who are at high risk for bleeding complications and secondly, to examine accurate documentation to decrease hemorrhagic complications among adult patients undergoing percutaneous coronary intervention (PCI). Background: Bleeding is one of the most common complications of PCI. The NCDR CathPCI bleeding risk score can predict patient risk for bleeding complications pre-procedurally. This tool is recognized as an assessment tool that can modify bleeding risk among adult patients undergoing PCI. This validated, individualized bleeding risk score (BRS) is useful in clinical decision making to promote quality of care, patient safety, and patient satisfaction and PCI outcomes. Specific outcomes evaluated in this project include number of blood transfusion and length of stay (LOS). Currently, this BRS tool is under utilized in the clinical setting. Methods: A cross sectional study design was implemented for this quality improvement project in a major medical center in the Northeast. Retrospective clinical data review was conducted for adult patients who underwent PCI prior to initiation of the NCDR CathPCI assessment tool. A data collection form was implemented to obtain this retrospective data related to bleeding complications. The NCDR CathPCI bleeding score tool was then implemented for adult patients who underwent PCI. Prospective data collection after implementing NCDR cathPCI bleeding risk tool is in progress. Results: The preliminary findings of the retrospective data review prior to implementation of the NCDR CathPCI bleeding score suggests that, 34.4% of the patients who received blood transfusions had documented bleeding complications (hematoma 15.6% (10 of 64); retro-peritoneal bleeding 9.4% (6 of 64); gastrointestinal bleeding 9.4% (6 of 64). Only 14.1% (9 of 64) of these patients had a drop in hemoglobin of 3grams from the baseline prior to transfusion. There was also a lack of documentation of hematoma size. Chronically anemic patients who received blood transfusion without bleeding complications accounted for 65.6% (42 of 64) of the patients reviewed in the retrospective data review. Average LOS of patients who required blood transfusion was an average of 1.34 days when compared with patients who did not develop bleeding complications. Final results of the prospective data analysis post implementation of the NCDR CathPCI assessment tool are pending. Conclusion: Pending.

Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis

Background contextElective posterior lumbar fusion is a common surgical procedure, but reported length of hospital stay is variable (usually 3–7 days). The effect of a limited number of factors on length of stay (LOS) has previously been evaluated. However, multivariate analysis using LOS as a dependent variable to separate potentially confounding variables has not been performed. PurposeTo facilitate setting of realistic expectations and considering the significant costs of hospitalization, it would be ideal to have a clear understanding of the variables affecting LOS for this surgery. Study design/settingThis is a retrospective case series at a tertiary care center. Patient sampleOne hundred three patients undergoing elective, open, one- to three-level posterior lumbar instrumented fusion (with or without decompression) by the orthopedic spine service at our institution between January 2010 and June 2012 were included in the study. Outcome measuresLOS was determined from the date of surgery to the date of discharge. MethodsPreoperative factors (patient demographics, previous surgery, levels instrumented, American Society of Anesthesiologists [ASA] score, and major medical comorbidities including diabetes, hypertension, malignancy, pulmonary disease, or heart disease), intraoperative factors (complications, drain placement, estimated blood loss, blood transfusion, fluids administered, operating room time, and surgery time), and postoperative factors (drain removal, blood transfusion, complications, and discharge destination) were collected and analyzed with multivariate stepwise regression to determine predictors of LOS. “Postoperative complications” were excluded as an independent variable from the regression analysis because of its close relationship with LOS. No funding was received for the completion of this study, and there are no potential conflicts of interests. ResultsOur sample included 70 one-level, 26 two-level, and 7 three-level operations. Average LOS was 3.6±1.8 days (mean±SD) with the range 0 to 12 days. Of this cohort, 79% (81 of 103) had a stay of 4 days or less. The only preoperative variables associated with LOS in the multivariate model were age (p=.038) and ASA score (p=.001). History of heart disease (p=.005) was significantly associated with a decreased hospital stay. Intraoperative complications included six dural tears and one pedicle fracture. No intraoperative factors were found to be associated with a longer LOS. Postoperative complications occurred in 32% of patients (33 of 103). Common complications included anemia requiring transfusion (11), altered mental status (8), pneumonia (4), hardware complications requiring reoperation (3). Only one serious complication, renal failure, occurred. Average LOS for patients with a postoperative complication was 5.1±2.3 vs. 2.9±0.9 days for patients with no complication (p<.001). Discharge to a subacute or nursing facility (p<.001) was significantly associated with increased LOS. Levels fused were not predictive of LOS, possibly due to the skew toward one-level cases in our sample. ConclusionPatients who are older and have widespread systemic disease tend to stay in the hospital longer after surgery. Contrary to our expectations, no single comorbidity was predictive of longer hospital stays. Heart disease was associated with a shorter LOS, but this may have been due to a more extensive preoperative workup and closer medical management. Intraoperative events did not affect LOS; however, postoperative events did. These data should prove useful for counseling patients and setting expectations of patients and the health care team.

Impact of the Implementation of Clinical Pathway on Postoperative Infection Rate

Objectives. To study the impact of the implementation of clinical pathway (CP) on the control of nosocomial infection and to provide an evidence for the management of infection. Methods. We compared and analyzed the average length of stay (LOS), antimicrobial drug usage, catheter and infection rate before and after the implementation of CP, by surveying the conditions of general surgical patients who underwent radical gastrectomy, radical resection of rectal carcinoma and modified radical mastectomy, without the implementation of CP, in 2009, and with the implementation of CP, in 2010. Results. The average LOS of the three categories of surgical patients after the implementation of the CP was significantly shortened, the average LOS of patients who underwent radical gastrectomy was shortened by 6.1 days, the average LOS of patients who underwent radical resection of rectal carcinoma was shortened by 6.29 days, and the average LOS of the patients who underwent modified radical mastectomy was shortened by 6.3 days. The antimicrobial drug usage was significantly reduced, wherein the usage of one antibacterial drug was increased by 25.05%, and the usage of a combination of two antimicrobial drugs was decreased by 19.26%; the usage of a combination of three antibiotics was decreased by 4.5%, while the usage of a combination of four antimicrobial drugs was decreased by 2.13%. The rate of nosocomial infection was decreased from 5.64% to 3.28%. The average number of days of requirement of a urinary catheter and deep vein catheterization was decreased significantly. It was statistically significant (P<0.001). Conclusions. The CP regulates the behavior of medical care staff, strengthens the execution of infection control measures, reduces the risk factors for infection, and effectively reduces the infection rates.

Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series

Introduction:Migraine headaches requiring an emergency department visit due to failed outpatient rescue therapy present a significant challenge in terms of length of stay (LOS) and financial costs. Propofol therapy may be effective at pain reduction and reduce that length of stay given its pharmacokinetic properties as a short acting intravenous sedative anesthetic and pharmacodynamics on GABA mediated chloride flux.Methods:Case series of 4 patients presenting to an urban academic medical center with migraine headache failing outpatient therapy. Each patient was given a sedation dose (1 mg/kg) of propofol under standard procedural sedation precautions.Results:Each of the 4 patients experienced dramatic reductions or complete resolution of headache severity. LOS for 3 of the 4 patients was 50% less than the average LOS for patients with similar chief complaints to our emergency department. 1 patient required further treatment with standard therapy but had a significant reduction in pain and a shorter LOS. There were no episodes of hypotension, hypoxia, or apnea during the sedations.Conclusion:In this small case series, sedation dose propofol appears to be effective and safe for the treatment of refractory migraines, and may result in a reduced LOS.

Observation for Nonoperative Management of Blunt Liver Injuries: How Long Is Long Enough?

Nonoperative management (NOM) of blunt liver injury is the standard of care in hemodynamically stable patients. However, there are no data regarding the optimum length of inpatient observation. The purpose of this study is to review NOM guidelines for patient safety and optimal length of stay (LOS). A retrospective review of the trauma registry at a Level I trauma center was performed to identify all patients admitted with blunt liver injuries. Guidelines for length of observation were developed, such that patients were discharged with normal physical examination and stable hemoglobin, regardless of grade of injury. Data collected include injury severity score, grade of liver injury, LOS, success rate of NOM, time to failure of NOM, and reason for failure of NOM. From August 2002 to March 2009, 591 patients were admitted for NOM of blunt liver injuries. Of these, 35 patients (6%) failed NOM; 19 failed secondary to hemorrhage, mostly from associated injuries. Average LOS for patients with isolated liver injuries was 2.2 days. Only one patient failed NOM as an outpatient. There were no adverse outcomes from these NOM guidelines. The length of observation should be based solely on clinical criteria. Patients with liver injuries may be safely discharged home in the presence of a normal abdominal examination and stable hemoglobin, regardless of the grade of injury. This guideline is safe and reduces LOS without increasing morbidity or mortality.

Cost analysis of intubation-related tracheal injury using a national database

Objective To perform risk analysis of tracheal injuries caused by endotracheal intubation (ETI) and to estimate the financial impact of these sequelae. Study Design Cost analysis using a national database. Settings The Agency for Healthcare Research and Quality (AHRQ) 2006 National Inpatient Sample. Subjects and Methods We identified clinical manifestations and treatments of complications associated with endotracheal tubes and codified them into International Classification of Disease-ninth revision diagnosis and procedure codes, intentionally excluding alternative etiologies of tracheal injury. Using the AHRQ 2006 National Inpatient Sample, we then compared patients with tracheal injury coded during the medical or surgical stay for length of stay (LOS) and mean hospital cost with diagnosis-related group (DRG)-matched controls; we also examined readmissions treating tracheal injury. Results Tracheal injury presents as tracheal stenosis, tracheomalacia, tracheoesophageal fistula, laryngotracheal ulceration, and vocal cord paralysis. A total of 3232 discharge records met criteria for tracheal injury from ETI within the index hospital stay. Average LOS for patients with tracheal injury (6.3 days; 95% confidence interval [CI] 6.0-6.3) exceeded LOS in the uncomplicated sample (5.2 days; CI 5.1-5.3) by 1.1 days. The average hospital cost was $1888 higher with tracheal injury ($10,375 [CI $9762-$10,988] vs $8487 [CI $8266-$8669]). LOS for procedures treating prior tracheal injury averaged 4.7 days and cost an average of $11,025 per discharge. Conclusion Tracheal injury from ETI is associated with a significant increase in healthcare costs that accrue both during the index admission and during subsequent hospitalizations required to treat the injury.

Average length of stay in hospice for five cancers

6593 Background: Factors which influence average length of stay (ALOS) for terminally ill cancer patients who choose hospice include patient and family preferences, availability of services, demographics, specialty, and experience of referring physician, advances in treatment options, and especially type of cancer. In this paper, we examined differences in ALOS for the top five cancers in patients who utilized a large, national hospice provider between 2000 and 2007. Methods: We reviewed the records of 73,263 patients with prostate, colorectal, breast, lung, or pancreatic cancer who were admitted to one of 45 hospice programs and died on service between January 2000 and December 2007. The top five cancers accounted for 58% of all cancer deaths in the hospice programs. The effect of type of cancer and year on ALOS was evaluated using analysis of variance. Pair-wise differences were compared using the Bonferroni correction. Results: Overall ALOS was 40.0 days (yearly range 37.8–41.1). ALOS for prostate, colorectal, breast, lung, and pancreas was 46.8, 44.9, 44.2, 37.3, and 31.4 days, respectively. Prostate, colorectal, and breast ALOS were not significantly different from one other; lung ALOS was less than the top three but greater than pancreas ALOS (p &lt; 0.001); and pancreas ALOS was significantly lower than all others (p &lt; 0.001). The interaction between year and type of cancer was not significant (p &gt; 0.05). Conclusions: The longer ALOS for patients with prostate, colorectal and breast cancer may be related to differences in natural history and effectiveness of anti-neoplastic therapies when compared to cancers of the lung and pancreas. Given the remarkable stability of ALOS over the last eight years and the lack of a statistical interaction between year and type of cancer, ALOS differences also suggest a steeper rate of decline for patients with cancers of the lung and pancreas following admission to hospice. No significant financial relationships to disclose.

Discrepancy between admission and discharge diagnoses as a predictor of hospital length of stay

The addition of clinical data or present on admission (POA) codes to administrative databases improves the accuracy of predicting clinical outcomes, such as inpatient mortality. Other POA information may also explain variation in hospital outcomes, such as length of stay (LOS), but this potential has not been previously explored. To assess whether a discrepancy between the diagnosis coded at the time of admission and the diagnoses coded at discharge independently explains variation in LOS for general internal medicine patients. A retrospective data review of patients age 18 years and older admitted to general internal medicine units at a large, urban academic medical center between July 2005 and June 2006. A generalized linear regression model was constructed to adjust for patient factors known to be associated with LOS. Average LOS among patients with a discrepancy between the admitting and discharge diagnosis codes versus those patients without a discrepancy. The average LOS for patients without a discrepancy between the admitting and discharge diagnosis codes, adjusted for comorbid conditions, was 3.4 days compared to 4.2 days with a discrepancy (0.76-day increase; P < 0.01). Diagnosis discrepancy is associated with longer LOS. Diagnosis discrepancy on admission may be a marker of diagnosis uncertainty or poor patient assessment/documentation. Further research is needed to understand the underlying reasons for this discrepancy and its association with LOS, and, potentially, clinical outcomes.

Hospital operations and length of stay performance

PurposeAs hospital costs continue to rise, increasing attention is being paid to the way these organizations are and should be managed. This attention typically comes in the form of focus on costs of services, quality (often measured through mortality rates) and length of stay. Hospital management has a broad array of choices at their disposal to address these challenges. As service operations, hospitals present a significant opportunity to apply the many tools and techniques from the field of operations strategy to this important industry. The objective of this paper is to use the operations strategy framework to assess the relationship between a set of operational elements and hospital performance in terms of average length of stay (ALOS), so that hospital managers improve the effectiveness and efficiency of patient care of their hospitals.Design/methodology/approachUsing the structural and infrastructural operations strategy framework, this study examines the relationship between several strategic variables and hospital performance. To analyze these relationships the paper employs data from the population of hospitals in New York State. The performance measure is the ALOS for patients, adjusted for the mix and severity of cases in each hospital.FindingsThe paper finds that a direct relationship exists between the dependent variable and location, capacity, and teaching status, and failed to find a direct relationship for capital expenditures, salary, and staffing levels. However, the paper did find significant interaction effects between capital expenses and both salary and staffing levels.Practical implicationsThere appear to be trade‐offs between capital expenditures and workforce decisions that have significant implications in light of current and expected hospital staffing shortages. The findings indicate that reductions in staff may not be perfectly replaced by corresponding increases in capital expenditures.Originality/valueThis paper further expands the body of research that addresses the important challenges hospitals face from an operations management perspective.

Average length of stay in hospice for five types of cancer

17038 Background: Factors which influence average length of stay (ALOS) for cancer patients who choose hospice include patient and family preferences, availability of hospice services, demographics, specialty and experience of referring physician, advances in treatment options, and type of cancer. In this paper, we examine trends in ALOS for the top five cancers in patients who utilized a large, national hospice provider between 2000 and 2006. Methods: We examined 61,457 patients with prostate, colorectal, breast, lung, or pancreatic cancer who were admitted to one of 40 hospice programs and died on service between 1/1/2000 and 11/30/2006. The top five cancers accounted for 58% of all cancer deaths in the Vitas programs. The effect of Type of Cancer and Year on ALOS was evaluated using analysis of variance. Pair-wise differences were compared using the Bonferroni correction. Results: Overall ALOS was 40.6 days. ALOS for prostate, colorectal, breast, lung and pancreas was 47.9, 45.6, 45.5, 37.8 and 31.7 days, respectively. Prostate, colorectal and breast ALOS were not significantly different from one other; lung ALOS was significantly less than the top three (p &lt; .001); and pancreas ALOS was significantly lower than all others (p &lt; .001). There was no evidence of yearly trends in ALOS for different cancers during the study period. Conclusions: ALOS for patients with one of the five leading cancers who elected hospice services prior to death has remained remarkably stable over the last seven years. This stability, combined with an overall ALOS of less than six weeks, suggests that much still needs to be done to maximize cancer patient utilization of hospice services. The somewhat longer ALOS for patients with prostate, colorectal and breast cancer may be related to differences in natural history and effectiveness of anti-neoplastic therapies when compared to cancers of the lung and pancreas. No significant financial relationships to disclose.

Changes in admissions, lengths of stay, and discharge diagnoses at a major university-affiliated teaching hospital

The implications for medical education of a declining average length of stay (ALOS) and changes in numbers of hospital admissions have been the subject of considerable discussion. The changing hospital reimbursement schedules and the rise of managed-care systems have altered patterns of hospital use and consequently posed new problems for the education of medical students and residents. Between 1980 and 1986 in one university-affiliated hospital, the ALOS for patients with any of the most frequent discharge diagnoses for either of those years had declined 34% since 1980, despite a 59% increase in the number of patients with those diagnoses. Patients with any one of 21 of the 88 most frequent discharge diagnoses for 1986 were hospitalized for less than one day. Those patients with another eight of the disorders had an ALOSs of between one and two days; some of these patients had serious and common gastrointestinal disorders. Discharge diagnoses were categorized by the hospital service in which students and residents would have rotations and were analyzed for changes in case mix. This study showed that for the hospital's medical students and residents to be exposed to the same case mix of clinical disorders that were seen in-hospital in 1980, it is now necessary for them to have experience in the ambulatory setting.