Admission day of the week impacts GI length of stay and charges

Introduction The weekend effect is a perceived difference in outcome between medical care provided at the weekend when compared to that of a weekday. Clearly multifactorial, this effect remains incompletely understood and variable in different clinical contexts. In this study we analyse factors relevant to the weekend effect in elective lower-limb joint replacement at a large NHS multispecialty academic healthcare centre. Materials and Methods We reviewed the electronic medical records of 352 consecutive patients who received an elective primary hip or knee arthroplasty. Patient, clinical and time-related variables were extracted from the records. The data were anonymised, then processed using a combination of uni- and multivariate statistics. Results There is a significant association between the selected weekend effect outcome measure (postoperative length of stay) and patient age, American Society of Anesthesiologists classification, time to first postoperative physiotherapy and time to postoperative radiography but not day of the week of operation. Discussion We were not able to demonstrate a weekend effect in elective lower-limb joint replacement at our institution nor identify a factor that would require additional weekend clinical medical staffing. Rather, resource priorities would seem to include measures to optimise at-risk patients preoperatively and measures to reduce time to physiotherapy and radiography postoperatively. Conclusions Our findings imply that postoperative length of stay could be minimised by strategies relating to patient selection and access to postoperative services. We have also identified a powerful statistical methodology that could be applied to other service evaluations in different clinical contexts.

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Effect of Total Joint Arthroplasty Surgical Day of the Week on Length of Stay and Readmissions: A Clinical Pathway Approach

The Journal of Arthroplasty ◽

10.1016/j.arth.2016.05.057 ◽

2016 ◽

Vol 31 (12) ◽

pp. 2726-2729 ◽

Cited By ~ 11

Author(s):

Paul K. Edwards ◽

Kristie B. Hadden ◽

Jacob O. Connelly ◽

C. Lowry Barnes

Keyword(s):

Length Of Stay ◽

Total Joint Arthroplasty ◽

Clinical Pathway ◽

Joint Arthroplasty ◽

Day Of The Week

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THE EFFECT OF A BOARDING RESTRICTION PROTOCOL ON EMERGENCY DEPARTMENT CROWDING

10.1101/2021.05.01.21255822 ◽

2021 ◽

Author(s):

Ji Hwan Lee ◽

Ji Hoon Kim ◽

Incheol Park ◽

Hyun Sim Lee ◽

Joon Min Park ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Primary Outcome ◽

Treatment Time ◽

Patient Flow ◽

Hospital Beds ◽

Before And After ◽

Day Of The Week ◽

Ed Crowding ◽

Post Period

ABSTRACT Background Access block due to a lack of hospital beds causes emergency department (ED) crowding. We initiated the boarding restriction protocol that limits ED length of stay (LOS) for patients awaiting hospitalization to 24 hours from arrival. This study aimed to determine the effect of the protocol on ED crowding. Method This was a pre-post comparative study to compare ED crowding before and after protocol implementation. The primary outcome was the red stage fraction with more than 71 occupying patients in the ED (severe crowding level). LOS in the ED, treatment time and boarding time were compared. Additionally, the pattern of boarding patients staying in the ED according to the day of the week was confirmed. Results Analysis of the number of occupying patients in the ED, measured at 10-minute intervals, indicated a decrease from 65.0 (51.0-79.0) to 55.0 (43.0-65.0) in the pre- and post-periods, respectively (p<0.0001). The red stage fraction decreased from 38.9% to 15.1% of the pre- and post-periods, respectively (p<0.0001). The proportion beyond the goal of this protocol of 24 hours decreased from 7.6% to 4.0% (p<0.0001). The ED LOS of all patients was similar: 238.2 (134.0-465.2) and 238.3 (136.9-451.2) minutes in the pre- and post-periods, respectively. In admitted patients, ED LOS decreased from 770.7 (421.4-1587.1) to 630.2 (398.0-1156.8) minutes (p<0.0001); treatment time increased from 319.6 (198.5-482.8) to 344.7 (213.4-519.5) minutes (p<0.0001); and boarding time decreased from 298.9 (109.5-1149.0) to 204.1 (98.7-545.7) minutes (p<0.0001). In the pre-period, boarding patients accumulated in the ED on weekdays, with the accumulation resolved on Fridays; this pattern was alleviated in the post-period. Conclusions The protocol effectively resolved excessive ED crowding by alleviating the accumulation of boarding patients in the ED on weekdays. Additional studies should be conducted on changes this protocol brings to patient flow hospital-wide.

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Surgical Scheduling Impacts Hospital Length of Stay and Associated Healthcare Costs for Patients Undergoing Total Hip and Knee Arthroplasty

HSS Journal ® ◽

10.1177/15563316211040055 ◽

2021 ◽

pp. 155633162110400

Author(s):

Sofia Ahsanuddin ◽

Daniel J. Snyder ◽

Hsin-Hui Huang ◽

Aakash Keswani ◽

Jashvant Poeran ◽

...

Keyword(s):

Length Of Stay ◽

Skilled Nursing Facility ◽

Hospital Length ◽

Postoperative Outcomes ◽

Hospital Length Of Stay ◽

Skilled Nursing ◽

Total Hip ◽

Surgical Scheduling ◽

Modifiable Factor ◽

Day Of The Week

Background: Surgical scheduling, specifically the day of the week on which surgery is performed, has been associated with various postoperative outcomes in patients undergoing lower extremity joint arthroplasty. Purpose: We sought to investigate surgical scheduling as a potential modifiable factor for patient quality metrics and related costs. Methods: In a retrospective prognostic study, all total knee and total hip arthroplasty (TKA/THA) cases that took place in 2017 to 2018 at a multihospital academic health system were queried. Patients were separated by the day of the week the surgery was performed, with Monday/Tuesday compared to Thursday/Friday. Outcomes included length of stay (LOS) (extended LOS defined as 3 days or longer), cost, and complications. Multivariable regression models measured associations between scheduling of surgery and outcomes; odds ratios (OR) and 95% confidence intervals (CIs) are reported. Results: Overall, 1,571 TKA and 992 THA patients were included (65% and 35%, respectively, performed on Monday/Tuesday and 70% and 30%, respectively, performed on Thursday/Friday). Patients undergoing TKA on Monday/Tuesday versus Thursday/Friday had higher American Society of Anesthesiologists scores (42% vs 33% with score of 3 or higher) but less often an extended LOS (31% vs 54%; adjusted OR: 2.76, 95% CI: 2.22-3.46), lower skilled nursing facility costs (unadjusted mean, $12,515 vs $14,154) and lower home health aide costs (unadjusted mean, $3,793 vs $4,192). Similar patterns were observed in THA patients. Conclusion: These results from institutional data suggest that surgical scheduling is a modifiable factor possibly associated with postoperative outcomes. Furthermore, more rigorous study is warranted.

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Does the Day of the Week Heart Failure Patients Are Admitted Influence Length of Stay or Mortality Risk? Findings from OPTIMIZE-HF

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2007.06.662 ◽

2007 ◽

Vol 13 (6) ◽

pp. S174

Author(s):

Gregg C. Fonarow ◽

Nancy M. Albert ◽

Christopher M. O'Conner ◽

Wendy G. Stough ◽

Eduardo Nunez ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Mortality Risk ◽

Heart Failure Patients ◽

Day Of The Week

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Is Length of Stay Influenced by the Weekday On Which Lumbar Surgery is Performed?

Neurosurgery ◽

10.1093/neuros/nyy382 ◽

2018 ◽

Vol 85 (4) ◽

pp. 494-499 ◽

Cited By ~ 1

Author(s):

Ahilan Sivaganesan ◽

Clinton J Devin ◽

Inamullah Khan ◽

Panagiotis Kerezoudis ◽

Hui Nian ◽

...

Keyword(s):

Regression Analysis ◽

Length Of Stay ◽

Cost Savings ◽

Lumbar Spine Surgery ◽

Nursing Facilities ◽

Lumbar Surgery ◽

Lumbar Degenerative Disease ◽

Patient Disposition ◽

Quality And Outcomes ◽

Day Of The Week

Abstract BACKGROUND Reducing length of stay (LOS) in a safe manner has the potential to save significant costs for the care of patients undergoing elective lumbar spine surgery. Due to the relative absence on weekends of staff required for discharging patients to rehabilitation or nursing facilities, we hypothesize that patients undergoing lumbar surgery later in the week have a longer LOS than their counterparts. OBJECTIVE To analyze the effect of day of the week for lumbar surgery on LOS. METHODS Patients undergoing surgery for lumbar degenerative disease were prospectively enrolled in the multicenter quality and outcomes database registry. A multivariable proportional odds regression model was built with LOS as the outcome of interest and patient and surgical variables as covariates. RESULTS A total of 11 897 patients were analyzed. Among those discharged home, the regression analysis demonstrated significantly higher odds of longer LOS for patients undergoing surgery on Friday as compared to Monday (P < .001). Among those discharged to a facility, there were significantly higher odds of longer LOS for patients undergoing surgery on Wednesday (P < .001), Thursday (P < .001), and Friday (P = .002) as compared to Monday. CONCLUSION The findings of this study suggest that lumbar patients undergoing fusions and those discharged to a facility have longer LOS when surgery is later in the week. Scheduling these patients for surgery earlier in the week and ensuring adequate resources for patient disposition on weekends may lead to LOS reduction and cost savings for hospitals, payers, and patients alike.

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Does the Day of the Week a Mastectomy is Performed Influence Length of Stay?

The American Surgeon ◽

10.1177/000313481808400708 ◽

2018 ◽

Vol 84 (7) ◽

pp. 228-230

Author(s):

Julian Huang ◽

Anees Chagpar

Keyword(s):

Length Of Stay ◽

Day Of The Week

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Admission day of the week impacts GI length of stay and charges

Gastroenterology ◽

10.1016/s0016-5085(08)82006-9 ◽

2001 ◽

Vol 120 (5) ◽

pp. A403-A404

Author(s):

Janet R. Harrison ◽

Joel M. Roth ◽

Russell D. Cohen

Keyword(s):

Length Of Stay ◽

Day Of The Week

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LO54: A descriptive analysis of ED length of stay of admitted patients ‘boarded’ in the emergency department

CJEM ◽

10.1017/cem.2017.116 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S46

Author(s):

L. Salehi ◽

P. Phalpher ◽

R. Valani

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Descriptive Analysis ◽

High Volume ◽

Increased Risk ◽

Significant Difference ◽

Ed Overcrowding ◽

Day Of The Week ◽

The Mean ◽

The Impact

Introduction: Previous studies have shown a link between Emergency Department (ED) overcrowding and worse clinical outcomes, increased risk of in-hospital mortality, higher costs, and longer times to treatment. Prolonged ED Length of Stay (LoS) of admitted patients awaiting a bed on in-patient units has been identified as a major driver of ED overcrowding. The purpose of this study is to provide a descriptive analysis of ED LoS among admitted patients, and determine the impact of prolonged ED LoS on total hospital in-patient length of stay (IP LoS). Methods: We conducted a single-site retrospective study for the period between January 1-December 31, 2015 at a very high volume community hospital. All patients aged ≥18 years admitted from the ED to acute in-patient Medicine units were identified. We carried out overall descriptive analysis (including analysis of day-of-the-week variability) on ED LoS. The mean total IP LoS for those patients with ED LoS<12 hours, 12-24 hours, and ≥24 hours were calculated and analyzed using ANOVA and Tukey HSD tests. Results: A total of 6,961 individuals were admitted to the medical units over the 12-month period. The median and mean ED LoS for admitted patients were 22.9 hrs (IQR: 13.9 hrs- 33.1 hrs) and 25.6 hrs respectively. Using ANOVA, there was a statistically significant difference in means of ED LoS as a function of the day of the week (p<0.0001), with Mondays having the highest mean ED LoS (27.6 hrs), and Fridays having the lowest (23.1 hrs). The mean IP LoS for those with ED LoS<12 hours, 12-24 hours, and ≥24 hours, were 6.8 days, 6.9 days, and 8.5 days respectively, with a statistically significant difference between group means (p<0.0001). Multiple pairwise comparisons of group means showed a statistically significant (p<0.05) difference between mean IP LOS of those with an EDLOS≥24 hours and those with an EDLOS<24 hours. Conclusion: Preliminary results indicate that ED LoS≥24 hours among admitted patients was associated with an increase in total IP LoS.*In the next 1-2 months, we intend to explore the role of other independent variables (age, sex, comorbidity, isolation status, and telemetry) on total ED LoS, and its association with IP LoS.

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