Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. In Germany, ≤50% of patients are malnourished at the time of hospital admission , , .Malnutrition has been identified as an independent risk factor for morbidity and mortality that is associated with a significantly longer hospital length of stay (LOS) for malnourished patients , , , thus the need for comprehensive screening programs has been acknowledged. Methodology, Bone marrow transplant (OR 18.39 [95% CI 12.50-27.05, p<0.001), complex infectious diseases such as systemic mycoses and parasitoses (OR 4.65 [95% CI 3.40-6.63, p<0.001), and complex abdominal diseases such as intestinal fistula (OR 2.57 [95% CI 1.98-3.32) had the greatest risk for PLOS. Writing – review & editing, Affiliation (2018) Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. Also, certain diagnosis groups had an increased risk for PLOS, such as bone marrow transplant, fungal and bacterial infections, hematological neoplasms, complex intestinal and abdominal disorders, tuberculosis, and HIV-related infections, among others. Key Points. https://doi.org/10.1371/journal.pone.0207203, Editor: Lars-Peter Kamolz, Medical University Graz, AUSTRIA, Received: August 23, 2018; Accepted: October 26, 2018; Published: November 8, 2018. No, Is the Subject Area "Cancer detection and diagnosis" applicable to this article? Prolonged length of stay after posterior surgery for cervical spondylotic myelopathy in patients over 65years of age. There are two potential explanations for this “weekend effect” at our institution: 1) Hospital staffing (physician to patient ratio) is lower on weekends and, 2) patients with complicated diseases referred from other hospitals (outside Mexico City) are admitted predominantly on weekends. PLoS ONE 13(11): There are several factors which contribute to an increase in patient length of stay: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Men had a slightly increased risk for PLOS than women (aOR 1.077, 95% CI 1.054–1.101), as well as early readmissions (aOR 1.05, 95% CI 1.02–1.09) and admission on weekends (Table 3). These could serve to develop a specific model of directed hospital healthcare for patients identified as in risk of PLOS. The black, vertical, boxplots illustrate the annual adjusted odds ratios (aORs) for prolonged stay of hospitalization (PLOS) using 2000 as the year of reference. -, Williams TA, Ho KM, Dobb GJ, Finn JC, Knuiman M, Webb SA, et al. When compared to NLOS, events of PLOS showed a greater proportion of admissions from the ED (28.8% vs 11.0%, p<0.001), were more likely to be admitted on weekends (36.5 vs 30.9%, p<0.001), and were more likely to occur in shared rooms (78.1 vs 71.9%, p<0.001). We also identified that emergency hospitalizations that required any type of surgical intervention ("emergency, surgical”) had the highest risk of PLOS in comparison to “elective, non-surgical” events of hospitalization (aOR 5.07, 95% CI 4.84–5.30). These groups were organized and agreed by all authors considering frequency of the disease or surgery and specific clinical characteristics (e.g. In our institution, that corresponded to ≥34 days. Length of stay (LOS) is an important measure of resource utilization as patients with prolonged LOS disproportionately account for the consumption of more hospital resources [].Prolonged LOS, which is defined as inpatient stay that exceeds the expected LOS for a certain procedure [], unnecessarily utilizes hospital beds, contributing to capacity shortage. Hendarto A, Putri ND, Yunita DR, Efendi M, Prayitno A, Karyanti MR, Satari HI, Hadinegoro SRS, Chan M. Front Pediatr. Introduction Healthcare-associated infections (HAIs) are a major health concern and have substantial effects on morbidity and mortality and increase healthcare costs. https://doi.org/10.1371/journal.pone.0207203.g002. Additionally, these patients represent a significant economic problem on public health systems and their families. A descriptive and comparative analysis of PLOS and NLOS patients was conducted. Additionally, these patients represent a significant economic problem on public health systems and their families. Information regarding physician-to-patient ratios and outcomes is scarce, but there is some evidence suggesting that increasing physician supply might reduce mortality and ED admissions [8]. The PLOS ONE Staff Distribution of prolonged length of…, Fig 1. Yes Conceptualization, Available at, Marshall A, Vasilakis C, El-Darzi E. Length of stay-based patient flow models: recent developments and future directions. No, Is the Subject Area "Critical care and emergency medicine" applicable to this article? The main diagnosis at hospital discharge or death, was considered the reason for hospitalization. Recent research suggests that improvements in efficiency during the inpatient stay can lower LOS without increasing unnecessary readmissions. Objective: To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. Patient-level hospital costs and length of stay after conventional versus minimally invasive total hip replacement: a propensity-matched analysis. 1-3 Hospital length of stay (HLOS) has been shown to predict functional decline for older adults, with longer HLOS associated with a greater likelihood of decline. -, Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. This could explain the increased risk of PLOS in this population. We conducted a retrospective analysis of hospital discharges from January 2000-December 2017 using institutional databases of medical records. Background: Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. We used Stata v12 software (StataCorp, 2012, College Station, Texas) for all statistical analyses. No, Is the Subject Area "Surgical and invasive medical procedures" applicable to this article? Epub 2016 May 24. Fig 1. Malnourished patients are a population with documented longer length of stay, higher costs, and in-hospital complications [].Malnutrition is common among hospital patients with prevalence estimates between 20 and 50% [].The extant literature provides evidence that malnutrition is associated with increased length in stay and hospital readmission [1, 3,4,5]. Validation, Overcrowding in emergency departments is a problem in many countries around the world, including the United States and Chile. increase length of stay and stall patient flow. eCollection 2020. Peterson K, Helfand M, Humphrey L, Christensen V, Carson S. 2013 Feb. Clipboard, Search History, and several other advanced features are temporarily unavailable. We hypothesize that changes in the infrastructure, organization and logistics in our hospital might account for these trends. Adjusted risk of a prolonged length of stay (PLOS) event by diagnosis at…, Fig 3. Our higher mortality could be explained, partly, by the fact that our study was conducted in a tertiary care referral hospital, included patients admitted from the ED and ICU and that we considered the 95th percentile as a cut-off point to define PLOS. After adjusting for the discharge diagnosis, we identified that age was independently, but weakly associated in an inverse manner with the risk of PLOS (1.2% risk reduction for each increasing year of age, 95%CI 1.1%-1.2%). During the study period there was an important reduction in the proportion of elective and urgent surgical events of hospitalization (dark and light gray bars). Get the latest research from NIH: https://www.nih.gov/coronavirus. OBJECTIVETo determine whether a multidisciplinary mobility promotion quality‐improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS).PATIENTS AND METHODSImplemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. This is the first study analyzing risk factors for PLOS in Mexico and Latin America and herein we provide useful information from a large number of hospitalizations. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0207203, https://doi.org/10.1371/journal.pone.0209944, http://apps.who.int/nha/database/Country_Profile/Index/en. Hematological neoplasms were the most common discharge diagnosis and surgery of the small bowel was the most common type of surgery. HHS Although the latter term has not been standardized, overall, these patients have worse outcomes, both from the health and socioeconomic perspectives[3–5]. The International Classification of Diseases, in its 9th version was used for codification of surgeries and its 10th version for diagnoses. The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not. Hence, we sought to describe the frequency of PLOS in a tertiary healthcare referral center located in Mexico City, analyze changes in LOS through time, describe the characteristics of the events of hospitalization associated to PLOS, and identify factors associated with this outcome. 1 Length of stay (LOS) is an aspect of care that can be costly for most healthcare systems if … e0207203. Tapia-Rombo CA, Ugarte-Torres RG, Alvarez-Vázquez E, Salazar-Acuña AH. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. Investigation, Hospitals benefit from a shorter LOS. The operational indicator for hospital LOS is the average length-of-stay, and by this measure patients may be classified as those with a Normal Length-Of-Stay (NLOS) and those with a Prolonged Length-Of-Stay (PLOS). The increase varies according to hospital level, region, site of infection, and infected pathogen, and it also varies if the pathogens were multidrug-resistant. Writing – review & editing, Affiliation Methodology, Younger age, male gender, a lower physician-to-patient ratio, emergency and weekend admissions, surgery, the number of comorbidities, residence outside Mexico City and lower socioeconomic status were associated with PLOS. Distribution of prolonged length of stay (PLOS) events by type of hospitalization from…, Fig 2. Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. We excluded hospitalization events that were exclusively managed in the Emergency Department [ED], in the Intensive Care Unit [ICU] or both (N = 5,441). A gout flare was reported in 42 of 326 admissions (13%) and the median length of stay for patients with a gout flare was longer than that of those without a flare (10 vs 6 days) or without gout (6 days). Finally, given that a significant proportion of patients (especially patients with PLOS) are not able to pay for their whole hospital stay, this also impacts the budget of the institution (in 2015, patients with PLOS at our Institution only covered 15.7% of their total hospitalization expenses; unpublished data). eCollection 2018. This particular population should be further analyzed to dilucidate which specific factors of surgical interventions are associated with PLOS, which could aid in the design of preventive strategies for PLOS and other outcomes (e.g. A health care-acquired infection (HAI) is defined as an infection occurring during the process of care in a hospital or other health care facility, neither present nor incubating at the time of admission nor at the time of a visit to a health care facility. PLoS One. Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients. The percentage increased from 2.4% in 2000 to 7.6% in 2007, then declined slightly in the ensuing years and remained stable during 2009–2016 with a later peak in 2017. Visualization, Data are available upon request from the Department of Medicine of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Ethics and Research Committee. Conceptualization, We sought to describe and compare characteristics of patients with Normal hospital Length-of-Stay (NLOS) and PLOS to identify sociodemographic and disease-specific factors associated with PLOS in a tertiary care institution that attends adults with complicated diseases from all over Mexico. De la Garza-Ramos R, Goodwin CR, Abu-Bonsrah N, Jain A, Miller EK, Neuman BJ, Protopsaltis TS, Passias PG, Sciubba DM. Writing – original draft, 2001 Jul-Aug;32(4):304-11. doi: 10.1016/s0188-4409(01)00281-8. Roles This contrasts with our results, and could be explained by a regional effect, as male patients in Mexico tend to seek less medical attention[18] which may translate in a more severe disease status at admission. 2009 Mar;15(3):273-9. doi: 10.1002/lt.21731. We report some key sociodemographic and disease-specific differences in patients with PLOS. We also include the calendar-year in our model, and show the adjusted odds ratios for PLOS per calendar-year in Fig 3, Panel B, where we can observe that the adjusted risk of PLOS increases sharply between 2003 and 2007 in comparison to 2000, and then decreased afterwards in such degree of magnitude that the adjusted odds ratio of PLOS is lower in any calendar-year after 2012 in comparison to 2000. The black, dotted line, summarizes the annual median length-of-stay (LOS) in days across time, during the study period. Value in Health, 15(8), 999-1004. Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. 2011–. Hospital inpatient care makes up nearly one-third of all healthcare expenditures in the United States, and represents a significant impact on the country’s economy. PLoS One. We observed that patients residing outside Mexico City had an increased risk for PLOS. Hospitalizations in shared rooms have been reported to increase the risk of PLOS[15], but we did not observed this phenomenon in our population. Some degree of malnutrition has been reported in 30–50% of hospitalized patients. here. 4-6 HLOS has been decreasing in recent decades. Hospitalization often results in a decline in functioning for older adults due to interactions of aging, disease, and hospital factors. Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. The median socioeconomic level was 3 [IQR 2–4]. For those that survive their stay in the ED and are transferred to the general hospital wards, a more comprehensive diagnostic approach and therapeutic management is often required. We used multiple chained equations to impute missing data with 10 imputations. Is the Subject Area "Cancer risk factors" applicable to this article? Overall, this study provides data to guide research models that could culminate in public health policies to assess efficacy of healthcare at other public institutions and/or hospitals and prevent or correct risk factors for PLOS. No, Is the Subject Area "Mexico" applicable to this article? The adjusted risk of PLOS increased between 2000 and 2007, then substantially and continuously decrease afterwards despite a sustained percentage of PLOS episodes after 2008. https://doi.org/10.1371/journal.pone.0207203.g003, https://doi.org/10.1371/journal.pone.0207203.t003. Overall, in-hospital crude mortality was 4.2% (n = 3,623). -. https://doi.org/10.1371/journal.pone.0207203.s001, https://doi.org/10.1371/journal.pone.0207203.s002. Methodology, (A) Overall Distribution of PLOS events by type of hospitalization (elective or emergency and surgical and non-surgical). HAI can significantly increase the LOS. PLOS were defined as those above the 95th percentile of length of hospitalization. Odds ratios for PLOS by diagnosis at discharge were adjusted for age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status using multinomial logistic regression models fixing “Diseases of the liver, biliary tract and pancreas (K70.0-K79.9, K83.0-K89.9)” as the reference group. Also, patients receiving care at our institute are expected to have diseases of high-risk for PLOS; thus, it may be challenging to extrapolate our results to other medical institutions in our country. The amount of transfused blood was predictive of in-hospital mortality, with an odds ratio of 1.4 for each unit of blood received. Every hospitalization episode was associated to an individual patient’s institutional registry number. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. The modifiable risk factors include: physician-to-patient ratio and, potentially, the day of admission (weekday vs weekends). We analyzed 85,904 hospitalizations (1,069,875 bed-days), of which 4,427 (5.1%) were PLOS (247,428 bed-days, 23.1% of total bed-days). Faced with declining revenue related to changes in Medicare and Medicaid reimbursements, Memorial Hospital at Gulfport knew additional methods of providing more efficient and cost-effective quality care were needed to maintain long-term success. Writing – review & editing, Roles In an adjusted analysis of 129 VA hospitals over 14 years, published in Annals of Internal Medicine in December 2012, researchers found that an intense focus on efficiency led to decreases in both LOS (down 27%) and 30-day readmissions (down 16%) as well as fewer deaths from any cause at 30 and 90 days after admission. -, Pirson M, Martins D, Jackson T, Dramaix M, Leclercq P. Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals. Quantitative variables were compared with a Student’s t test or a Mann-Whitney U test, according to their distribution after applying skewness and kurtosis tests for normality. It can also improve outcomes by minimizing the risk of hospital-acquired conditions. Moreover, despite the relevance of LOS in healthcare administration and healthcare epidemiology, there is a lack of knowledge about factors related to LOS in Mexico and Latin America. Further investigations to identify other presently unaccounted changes in hospital infrastructure, organization and logistics are needed to better characterize this observation. PLOS were found to have a lower median socioeconomic status in our study, which further accentuates this issue. The increased LOS of GI wa… Median age at hospitalization was 51-years old (yo) (IQR 35–66). The author(s) received no specific funding for this work. Briefly, PLOS events occurred among younger people (48 years [IQR 32–62] vs 52 years [IQR 35–66], p<0.001); and had a lower median socioeconomic level (2 [IQR 2–3] vs 3 [IQR 2–4], p<0.001). The number of comorbidities and lower socioeconomic status were also associated with an increased risk of PLOS, as previously reported[21]. Considering that up to 44% of the health expenditure in Mexico is out-of-pocket, these numbers become extremely relevant due to the profound impact patients with PLOS have on the economy of their families, frequently leading to catastrophic health expenditure [23, 24]. An explanation for this is difficult. We compared NLOS and PLOS using descriptive and inferential statistics. Our findings could serve to develop a specific model of directed hospital healthcare once these factors are identified at admission and/or during hospitalization. The longer a patient stays in the hospital, the greater the risk they will develop a healthcare-acquired infection (HAI) that they can become vulnerable to. Health Care Manag Sci. For a five-night stay, this increased to a 5.5 per cent chance of a drug reaction, a 17.6 per cent chance of a hospital-acquired infection and a 3.1 per cent chance of an ulcer. The percentage increased from 2.4% in 2000 to 7.6% in 2007, then declined slightly in the ensuing years and remained stable during 2009–2016 with a later peak in 2017. Admission through the ED increased the risk of PLOS in our study, as previously reported elsewhere[19, 20]. Conceptualization, Relationship between gender and risk of PLOS has been scarcely investigated, although female patients have been typically described as having more prolonged LOS [16, 17]. Visualization, There are some limitations to our study. A lower mortality among patients with PLOS (4.4%) has been reported in other studies[20]. 2016 Sep;31:137-41. doi: 10.1016/j.jocn.2016.02.017. Yes Visualization, For more information about PLOS Subject Areas, click Each patient move can add one or two nights to length of stay, and patients that are Funding: The author(s) received no specific funding for this work. No, Is the Subject Area "Hospitals" applicable to this article? PLOS were defined as those above the 95th percentile of length of hospitalization. Results: A hospital stay carries a 5.5% risk of an adverse drug reaction, 17.6% risk of infection, and 3.1% risk of ulcer for an average episode, and each additional night in hospital increases the risk by 0.5% for adverse drug reactions, 1.6% for infections, and 0.5% for ulcers. The relationship between length of in-hospital stay (LOS) and quality of care is difficult. Annual frequency of hospitalizations classified…. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Surgeries occurred in 62.5% of PLOS hospitalizations and in 40.7% of NLOS (p<0.001). Writing – review & editing, Roles Although an initial univariate analysis showed hospitalization in shared room to be a risk factor for PLOS, this effect did not persist after adjusting for socioeconomic level, which frequently determines the type of hospitalization room. Washington (DC): Department of Veterans Affairs (US); 2011–. Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not. Eur J Health Econ. In contrast, hospitalizations for solid organ transplantation (aOR 0.10, 95% CI 0.06–0.16), due to common surgical procedures (aOR 0.15, 95% CI 0.11–0.20), disorders of the genital tract (aOR0.22, 95% CI 0.15–0.34) including neoplasms (aOR 0.26, 95% CI 0.17–0.39), thyroid disorders (aOR 0.24, 95% CI 0.11–0.51), among others were associated with a decreased risk of PLOS (Fig 2). Finally, it is generally accepted that the leading determinant for a patient’s LOS is the main diagnosis. The twenty most common diagnoses are shown in Table 2. 2020 Sep 22;9(9):3055. doi: 10.3390/jcm9093055. 3 Assessment tools for the evaluation of nutritional status vary in their ability to predict LOS and morbidity. We used multinomial logistic regression models to control for age, gender, type of admission, recent hospital discharge, weekday/weekend admission, additional diagnoses, place of residence and socioeconomic status, using inverse probability weights based on diagnosis of admission. Additionally, these patients represent a significant economic problem on public health systems and their families. Hematological neoplasms were the most common discharge diagnosis and surgery of the small bowel was the most common type of surgery. Visualization, The authors have declared that no competing interests exist. Among the non-modifiable risk factors, we found that younger age, male gender, type of admission and hospitalization (specially emergency and surgical admissions), the number of comorbidities, place of residence (outside of Mexico City) and a lower socioeconomic status were associated with an increased risk of PLOS. J Pharm Policy Pract. Patient length of stay (LOS) is one of the biggest issues facing hospitals today. We defined PLOS events based on the 95th percentile LOS, which has been previously used [4]. Bone marrow transplant (OR 18.39 [95% CI 12.50–27.05, p<0.001), complex infectious diseases such as systemic mycoses and parasitoses (OR 4.65 [95% CI 3.40–6.63, p<0.001), and complex abdominal diseases such as intestinal fistula (OR 2.57 [95% CI 1.98–3.32) had the greatest risk for PLOS. Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes. This is similar to our results (23.1% of total hospital bed-days). (2018) Our study was not specifically designed to test these hypotheses, but further studies may confirm this finding. This classification is similar to others previously published and validated [7]. In Fig 1 we show the hospitalization events according to four types of hospitalization, most hospitalizations were elective admissions with no surgical interventions performed during the hospitalization (“elective, non-surgical”, 50.8%); followed by elective admissions with surgeries performed during the hospitalization event (“elective, surgical”, 37.3%), emergency admissions with no surgeries performed during the hospitalization (“emergency, non-surgical”, 7.4%); and only a small proportion of hospitalizations were classified as “emergency, surgical”, 4.5%)(Fig 1, Panel A). Introduction. No, Is the Subject Area "Medical risk factors" applicable to this article? Further studies describing risk factors associated with mortality in our Institution are underway. Emergency department (ED) overcrowding causes problems for patients and staff, including increased waiting times, increased ambulance diversion, increased length of stay, increased medical errors, increased patient mortality, and increased harm to hospitals … Patient demographics, associated disease, length of hospital stay, morbidity and mortality were also evaluated. Yes PLOS hospitalizations occurred as early readmissions (≤30 days) more frequently than NLOS hospitalizations (33.6 vs 27.9%, p<0.001). Improving and reducing length of stay (LOS) improves financial, operational, and clinical outcomes by decreasing the costs of care for a patient. Validation, Validation, Most of these deaths occurred in the hospital ward, but a greater proportion of patients with PLOS died in the ICU in comparison with NLOS patients (35.0 vs 18.9%, p<0.001). Results showed significantly longer hospital stays for patients with a history of gout compared with those without gout (log length of stay, 1.86 vs 1.72 days, respectively; P =.0278). COVID-19 is an emerging, rapidly evolving situation. As hospitals and healthcare systems pinch pennies and look for ways to operate more efficiently, a new report reveals six simple steps they can take to reduce length of stay and increase … Importantly, we also observed important changes in the frequency of PLOS over time and the adjusted risk of PLOS, during the study period, which are more noticeable before and after 2007, when the trend in increased frequency of PLOS and adjusted risk of PLOS over time, reversed significantly. Younger age, male gender, a lower physician-to-patient ratio, emergency and weekend admissions, surgery, the number of comorbidities, residence outside Mexico City and lower socioeconomic status were associated with PLOS. Background: Investigation, Also, PLOS hospitalizations were associated with a higher in-hospital crude mortality (13.3% vs 3.7%, p<0.001). We analyzed 85,904 hospitalization events (1,069,875 bed-days) during the 18-year study period. (A) Overall Distribution of PLOS events by type of hospitalization (elective or emergency and surgical and non-surgical). Correction: Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. NIH 2010;104(4):459–64. To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. Only events that included at least one day of stay in the general hospital wards during their total hospitalization were included in the analysis. Discover a faster, simpler path to publishing in a high-quality journal. Main outcome measures: The National Hospital Discharge Survey (NHDS), 2005-2006, was evaluated for presence of dysphagia and the most common comorbid medical conditions. correction. diagnosis, prognosis, and treatment)(S1 and S2 Tables). J Clin Neurosci. 1 Malnutrition is associated with increased morbidity 2 and complications, and leads to increased length of hospital stay (LOS), therapeutic hospital and rehabilitation cost. Yes Results: Our hospital, a public tertiary healthcare referral center located in Mexico City, is one of the Mexican National Institutes of Health (MNIH) and provides healthcare to adult patients with complex diseases from all over the country. Surgery was performed in 41.8% of hospitalization events. e18936. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Validation, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Roles The black, vertical, boxplots illustrate the annual adjusted odds ratios (aORs) for prolonged stay of hospitalization (PLOS) using 2000 as the year of reference. Evidence Brief: Effectiveness of Intensive Primary Care Programs. Yes Yes 2018;13(4):e0195901 10.1371/journal.pone.0195901 ; PubMed Central PMCID: PMCPMC5898738. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Diagnoses and surgeries were classified in groups for analysis (55 diagnostic groups and 30 surgical groups). USA.gov. The frequency of PLOS was significantly higher during hospitalization events that required a surgical intervention. 2006;7(1):55–65. These comprise around 70% of all the hospitalizations, but their distribution differ by groups: 61.9% in PLOS and 72.9% in NLOS; thus, other less frequent diagnoses account for a greater proportion of PLOS events. In particular, being a retrospective, cross-sectional analysis, our study is highly susceptible to different types of bias and confounding.  |  On the other hand, our study derives information from a real-world medical records database that is systematically populated since 2000, so we have consistent information about our hospital discharges for a considerable period of time. El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. Click through the PLOS taxonomy to find articles in your field. Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 21 Dec 2018: http://apps.who.int/nha/database/Country_Profile/Index/en, World Health Organization. Blood transfusion was predictive of length of postoperative hospital stay and number of complications before discharge. VA Evidence Synthesis Program Evidence Briefs. In 2014, 44% of Mexicans’ health expenditure was absorbed by patients themselves, compared to 11% in the U.S.A.[1]. Competing interests: The authors have declared that no competing interests exist. Risk of mortality in patients with PLOS increased more than threefold (3.7% vs 13.3%, p<0.001). Annual frequency of hospitalizations classified as prolonged length-of-stay (PLOS) from 2000–2017. here. Liver Transpl. (A) The vertical, gray bars represent the annual percentage of hospitalization events classified as PLOS. We used multinomial logistic regression models to control for age, gender, type of admission, recent hospital discharge, weekday/weekend admission, additional diagnoses, place of residence and socioeconomic status, using inverse probability weights based on diagnosis of admission. Br J Anaesth. Evidence-based information on effects to patients of increased length of hospital stay from hundreds of trustworthy sources for health and social care. Finally, our analyses are adjusted to multiple factors, which increases the robustness of our results. At this institution there are 167 hospital beds available for admission, and the annual average of hospitalization events is 4772.4 (SD ± 346.6). Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Methodology, All data presented in this study originated for electronic health records that are identified by an individual institutional registry and should be managed securely. WHY LENGTH OF STAY MATTERS. Weekend admissions, another potentially modifiable risk factor for PLOS, have already been associated with increased risk of PLOS and other poor outcomes (e.g. 2005;8(3):213–20. from the wards to the ICU and back to the wards). We then fit a multivariate logistic regression model to estimate the risk of PLOS including age, gender, physician-to-patient ratio, type of admission, rehospitalization at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status, and used inverse probability weights (IPW) to adjust for the effect of the discharge diagnosis on LOS. Categorical variables were compared using the chi-squared test. Setting We used data of 61 Dutch hospitals.  |  See this image and copyright information in PMC. This site needs JavaScript to work properly. (A) The vertical, gray bars represent the annual percentage of hospitalization events classified as PLOS. In this study, we analyzed >85,000 episodes of hospitalization in a tertiary healthcare referral center in Mexico City over a 18-year period, and we found that NLOS and PLOS patients are quite a distinct populations. Other factors previously identified to be associated with PLOS are gender, hospitalizations in shared rooms, admissions through the ED, comorbidities and socioeconomic status. High length-of-stay outliers under casemix funding of a remote rural community with a high proportion of Aboriginal patients. Elective hospitalization events for surgical procedures increased the most during the study period. Hospitalizations events due to hematopoietic neoplasms (aOR 2.82, 95% CI 2.40–3.32), diseases of the peritoneum (aOR 2.82, 95% CI 2.33–3.41), complex intestinal and abdominal disorders (aOR 2.56, 95% CI 1.98–3.32), sepsis and severe bacterial infections (aOR 2.21, 95% CI 1.78–2.72), tuberculosis (aOR 2.05, 95% CI 1.52–2.78), peripheral nerve and muscle disorders (aOR 1.95, 95% CI 1.41–2.69), inflammatory bowel disease (aOR 1.74, 95%CI 1.25–2.15), among others also had an increased risk of PLOS (Fig 2). In addition, the unadjusted annual frequency of PLOS events and median LOS is summarized in Fig 3. NLOS patients were defined as those with a LOS <34 days. These were used to combine patient transfers within the different areas of our hospital (wards, ICU, ED) into a single continuous episode. On the other hand, to our knowledge this is the first study evaluating physician-to-patient ratio and its impact on LOS. Introduction. In addition, hospitals face lower patient capacities and increased costs. mortality). One of the best ways to improve a hospital’s financial margin is to reduce the average patient length of stay. Citation: Marfil-Garza BA, Belaunzarán-Zamudio PF, Gulias-Herrero A, Zuñiga AC, Caro-Vega Y, Kershenobich-Stalnikowitz D, et al. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. We sought to describe and compare characteristics of patients with Normal hospital Length-of-Stay (NLOS) and PLOS to identify sociodemographic and disease-specific factors associated with PLOS in a tertiary care institution that attends adults with complicated diseases from all over Mexico. doi: 10.1371/journal.pone.0209944.  |  By this measure, patients are classified in seven levels (1–7) which are inversely related to the magnitude of subsidy over health expenditure during hospitalization. Validation, . Materials and methods: Conclusions: Writing – review & editing, Affiliations These data are available for researchers following evaluation of a formal research proposal by the Ethics and Research Committee (contact: Department of Medicine, direccion.medicina@incmnsz.mx or direccionmedicina.incmnsz@gmail.com). LOS was considered from the day of hospital admission (regardless of the initial service of admission) to the day of hospital discharge or death (regardless of the service of discharge or death). No, Is the Subject Area "Socioeconomic aspects of health" applicable to this article? https://doi.org/10.1371/journal.pone.0209944 Background: Determining length of stay (LOS) and the attributable costs for hospital admissions are of critical importance for patients (Pts), providers, payers, and hospital management. NLM We analyzed our Institution´s hospital discharge database which contains information of all hospitalization events. There was no significant difference in the increased LOS between different hospital levels. Copyright: © 2018 Marfil-Garza et al. Conceptualization, These patients are typically admitted in a more critical condition and have a high mortality; we found a mortality of 8.4% for those admitted through the ED vs 3.7% for those admitted directly to the wards (p<0.001). We abide to the Principles of the Declaration of Helsinki. Furthermore, we corroborated the phenomenon of increased risk of early readmission in the non-surgical population compared to the surgical population (32.1% vs 21.9%, p<0.001) that has already been reported in other studies [11, 12]. Hospital-related functional decline in older patients and the subsequent harm has dreadful consequences for many patients, and is something we should not tolerate. Missing data was handled as described above. However, patients referred from other hospitals (frequently outside Mexico City), with diseases that require more complex diagnostic workup or therapeutic approach. Elective hospitalization events for surgical procedures increased the most during the study period. The black, dotted line, summarizes the annual median length-of-stay (LOS) in days across time, during the study period. First Pediatric Outpatient Parenteral Antibiotic Therapy Clinic in Indonesia. The study derived from an institutional monitoring program to assess LOS during 2016 and was later extended as a retrospective, cross-sectional analysis of all episodes of hospitalization from January 2000 to December 2017. During each event of hospitalization, patients could be transferred several times to different areas of the hospital depending on their clinical status (e.g. The binary logistic regression analysis of the discharge diagnoses demonstrated a predominance of complex diseases, such as hematological malignancies, complex infectious and intestinal/abdominal diseases and autoimmune diseases as risk factors for PLOS (Fig 2). First, to identify the risk of PLOS by group of diagnosis adjusting for potential confounders, we fit a multinomial logistic regression model for the 55 different diagnostic groups. An increased length of stay in the hospital not only increases the cost of health care but also adds to the risk of medical complications like infections and medical errors. The database is completed by both physicians and professionally trained personnel, which decreases codification errors. Ensuring the delivery of appropriate care and treatment is crucial for quality of care; length of stay in hospital may be irrelevant to this process. We compared the characteristics of hospitalization events by LOS (NLOS vs PLOS) in Table 1. For more information about PLOS Subject Areas, click Additionally, these patients represent a significant economic problem on public health systems and their families. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. We investigated the effect of a hospital-wide program for the prevention of HAIs on additional length of stay (LOS). Early readmissions (≤30 days), a measure of the quality of healthcare, are commonly considered as a risk factor for PLOS[10]. No informed consent was deemed necessary by our institution’s Ethics and Scientific Committees (Institutional Review Board) and the manuscript was evaluated and approved by these committees prior to submission for publication. View 2020 Jun 16;13:24. doi: 10.1186/s40545-020-00230-6. Surgical patients represent a considerable percentage of total hospitalizations events and risk factors for PLOS related to surgery have been previously described for several types of surgeries[13, 14]. Moreover, the median time for readmission was shorter in PLOS hospitalizations, both for early (11 vs 13 days, p<0.001) and late (201 vs 261 days, p<0.001) readmissions. Separately, to identify sociodemographic and clinical factors associated to PLOS controlling for the diagnosis of discharge, we fit a multinomial logistic regression model for PLOS based on the 55 different diagnostic groups. Even though PLOS patients typically represent a small percentage of the total population of hospitalized patients in other studies (3.6–5.6%)[22], they account for approximately 20% of hospital bed-days[6]. Data curation, Since hospitals are paid by the “DRG” (diagnosis related group), the hospital is going to get paid the same amount for a patient with say, pneumonia, if that patient spends 4 days in the hospital or spends 8 days in the hospital. The organization embraced the … “Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81.0-C96.9)” were the most common diagnosis in both populations. Arch Med Res. Yes Yes Methodology, Investigation, Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals. We conducted a retrospective analysis of hospital discharges from January 2000-December 2017 using institutional databases of medical records. Correction: Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. Predictors of prolonged length of hospital stay and in-hospital mortality among adult patients admitted at the surgical ward of Jimma University medical center, Ethiopia: prospective observational study. All data were de-identified and fully anonymized before the analysis. We would like to thank Fermín Alvarez-Hernandez, Head of the Clinical Record and Statistics Department at INCMNSZ for his assistance obtaining our Institution’s databases. Data Availability: There are ethical limitations on data sharing because the Institutional Ethics and Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, which approved this study, did not approve for public data availability. The median LOS for all hospitalization events was 8 days in 2000, peaked at 10 days in 2006 and 2007 and then declined to 8 days afterwards and up to 2015, when it declined again by one day (B). We report some key sociodemographic and disease-specific differences in patients with PLOS which include a younger age, male gender, a lower physician-to-patient ratio, emergency and weekend admissions, surgery, the number of comorbidities, residence outside Mexico City and lower socioeconomic status. 2020 Apr 15;8:156. doi: 10.3389/fped.2020.00156. Please enable it to take advantage of the complete set of features! The adjusted risk of PLOS increased between 2000 and 2007, then substantially and continuously decrease afterwards despite a sustained percentage of PLOS episodes after 2008. eCollection 2020. https://doi.org/10.1371/journal.pone.0207203.g001. The median hospital LOS for all events was 8 days (interquartile range [IQR] 5–14); 8 days for NLOS (IQR 5–13) and 45 days for PLOS (IQR 38–60). In our study, in-hospital crude mortality in patients with PLOS nearly tripled as compared to patients with NLOS. 10.1007/s10198-005-0331-0 . We used as reference “Diseases of the liver, biliary tract and pancreas (K70.0-K79.9, K83.0-K89.9)”, because it was the second largest diagnosis group (N = 6,426) and patients with PLOS and NLOS were equally distributed within this diagnosis group (7.7 vs 7.6%, respectively, p = 0.31). Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Russell-Weisz, D., & Hindle, D. (2000). Tefera GM, Feyisa BB, Umeta GT, Kebede TM. Global Health Expenditure Database. We compared NLOS and PLOS using descriptive and inferential statistics. Such difference highlights the need for strategies to control health expenditure in Mexico and to evaluate healthcare efficiency and resource utilization, particularly, concerning health expenditure on hospitalized patients. PLOS ONE promises fair, rigorous peer review, https://doi.org/10.1371/journal.pone.0207203.t002, After adjusting for age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status, we observed that hospitalization events associated to bone marrow transplant had the highest risk of PLOS (aOR = 18.4, 95% CI = 12.50–27.05); followed by systemic mycoses and parasitosis (aOR 4.6, 95% CI 3.9–6.4)(Fig 2). Project administration, The frequency of PLOS was significantly higher during hospitalization events that required a surgical intervention. Writing – review & editing, Roles We explored the utility of the UL-LOS indicator. Still, factors leading to this “weekend effect” are not completely understood[9]. We included age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnoses, place of residence and socioeconomic status. We identified several risk factors for PLOS, that can be grouped as modifiable (perhaps preventable) and other non-modifiable, both recognizable at hospital admission. . 2018 Dec 21;13(12):e0209944. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Roles Smith JO, Shiffman ML, Behnke M, Stravitz RT, Luketic VA, Sanyal AJ, Heuman DM, Fisher RA, Cotterell AH, Maluf DG, Posner MP, Sterling RK. broad scope, and wide readership – a perfect fit for your research every time. The HAI caused an increase in stay of 10.4 days. The median LOS for all hospitalization events was 8 days in 2000, peaked at 10 days in 2006 and 2007 and then declined to 8 days afterwards and up to 2015, when it declined again by one day (B). Hospital Length-Of-Stay (LOS) refers to the total bed-days occupied by a patient during his hospitalization, and it has been used as a traditional surrogate to evaluate efficiency of healthcare, effectiveness of preventive and therapeutic strategies, diagnostic methods, clinical pathways, as well as hospital resource utilization, allocation, and administration[2]. • A stay in hospital over 10 days leads to 10 years of muscle ageing for some people who are most at risk (see Section 12 for the evidence). The goal of the present study was to evaluate oncology Pts receiving inpatient … Accesed on 07/19/2016. Surgical hospitalizations showed an increased risk for PLOS, both when elective (aOR 2.92, 95% CI 2.85–2.99) or emergency (aOR 5.07, 95% CI 4.84–5.30) admissions were considered. Socioeconomic status is a construct used by the MNIH that comprises the following elements: monthly household income, family’s main provider’s occupation, monthly household expenses, housing conditions and family’s health status. During the study period there was an important reduction in the proportion of elective and urgent surgical events of hospitalization (dark and light gray bars). We report some key sociodemographic and disease-specific differences in patients with PLOS. Question Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care?. We analyzed 85,904 hospitalizations (1,069,875 bed-days), of which 4,427 (5.1%) were PLOS (247,428 bed-days, 23.1% of total bed-days). Moreover, there is an apparent, multiplicative interaction between urgent hospitalizations that require surgical interventions. Visualization, Ofori-Asenso R, Liew D, Mårtensson J, Jones D. J Clin Med. Increased LOS can sometimes be due difficulties in coordinating a safe and timely discharge plan. Conceptualization, Briefly, the crude frequency of PLOS increased between 2000 and 2007 from 2.4% to 7.6%, and then decreased the following three years to 5%, and appears to stabilize and vary between 5% to 6% until the end of the study. (B) Annual trends of the distribution of type of hospitalization. Get the latest public health information from CDC: https://www.coronavirus.gov. While these, and other potentially unaccounted changes in organization occur gradually; we identified that increasing the physician-to-patient ratio, which occurred in February 2008, was associated to a decreased risk of PLOS. PLOS has already been described as a risk factor for mortality, and previous studies in Mexico have reported that patients with a LOS >21 days have increased mortality (OR 2.41 [CI 95% 2.30–2.51])[25]. Research has found that patients can be moved four or five times during a hospital stay, often with incomplete notes and no formal handover (Cornwell and others, 2012; Royal College of Physicians, unpublished). mortality). Investigation, Odds ratios for PLOS by diagnosis at discharge were adjusted for age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status using multinomial logistic regression models fixing “Diseases of the liver, biliary tract and pancreas (K70.0-K79.9, K83.0-K89.9)” as the reference group. This change also led to a progressive decrease in the median LOS, which further supports the robustness of this measure. These could serve to develop a specific model of directed hospital healthcare for patients identified as in risk of PLOS. The following variables were evaluated for all episodes of hospitalization: LOS in days, age at discharge in years, gender, type of admission (elective or emergency), type of hospitalization (as previously described[6]; “elective, non-surgical”, “elective, surgical”, “emergency, non-surgical”, and “emergency, surgical”), type of hospital bed (shared or private), physician-to-patient ratio (20 beds per medical team [January 2000-February 2008] or 12 beds per medical team [March 2008-December 2017]), day of admission (weekday [Monday-Thursday] or weekend [Friday-Sunday]), total number of events of hospitalization, number and type of readmission (early: ≤30 days from a previous hospitalization event or late: >30 days from a previous hospitalization event), days to readmission, surgery (only those procedures occurring in operating rooms), number of surgeries during hospitalization event, number of additional diagnoses (comorbidities), place of residence, diagnosis at discharge, socioeconomic status, in-hospital crude mortality and location of death (hospitalization ward, ED or ICU). 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