scholarly journals P067: Factors associated with prolonged length of stay of admitted patients in a tertiary care emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S101
Author(s):  
K. Johns ◽  
S. Smith ◽  
E. Karreman ◽  
A. Kastelic
Keyword(s):  
Length Of Stay ◽  
Multiple Regression ◽  
Significant Relationship ◽  
Demographic Data ◽  
Healthcare Access ◽  
Tertiary Care ◽  
Outcome Variable ◽  
Prolonged Length ◽  
Patient Demographic Data ◽  
Major Predictor

Introduction: Extended length of stay (LOS) in emergency departments (EDs) and overcrowding are a problems for the Canadian healthcare system, which can lead to the creation of a healthcare access block, a reduced health outcome for acute care patients, and decreased satisfaction with the health care system. The goal of this study is to identify and assess specific factors that predict length of stay in EDs for those patients who fall in the highest LOS category. Methods: A total of 130 patient charts from EDs in Regina were reviewed. Charts included in this study were from the 90th-100th percentile of time-users, who were registered during February 2016, and were admitted to hospital from the ED. Patient demographic data and ED visit data were collected. T-tests and multiple regression analyses were conducted to identify any significant predictors of our outcome variable, LOS. Results: None of the demographic variables showed a significant relationship with LOS (age: p=.36; sex: p=.92, CTAS: p=.48), nor did most of the included ED visit data such as door to doctor time (p=.34) and time for imaging studies (X-ray: p=.56; ultrasound: p=.50; CT p=.45). However, the time between the request for consult until the decision to admit did show a significant relationship with LOS (p<.01).Potential confounding variables analyzed were social work consult requests (p=.14), number of emergency visits on day of registration (p=.62), and hour of registration (00-12 or 12-24-p<.01). After adjustment for time of registration, using hierarchical multiple regression, time from consult request to admit decision maintained a significant predictor (p<.01) of LOS. Conclusion: After adjusting for the influence of confounding factors, “consult request to admit decision” was by far the strongest predictor of LOS of all included variables in our study. The results of this study were limited to some extent by inconsistencies in the documentation of some of the analyzed metrics. Establishing standardized documentation could reduce this issue in future studies of this nature. Future areas of interest include establishing a standard reference for our variables, a further analysis into why consult requests are a major predictor, and how to alleviate this in the future.

scholarly journals Admission Pattern and Outcome in a Pediatric High Dependency Care (PHDC) Unit of a Tertiary Care Children Hospital in Bangladesh

2015 ◽  
Vol 4 (2) ◽  
pp. 27-30
Author(s):  
Mohammed Reaz Mobarak ◽  
AKM Tajuddin Bhuyian ◽  
Md Rafiqul Islam ◽  
Ferdousi Begum ◽  
Md Atiqul Islam ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Very Low Birth Weight ◽  
Demographic Data ◽  
Tertiary Care ◽  
Case Fatality ◽  
Acute Bronchiolitis ◽  
Female Ratio ◽  
Dependency Care ◽  
High Dependency ◽  
High Dependency Care

Pediatric high dependency care (PHDC) is a care comprising of close observation, monitoring and management of children who are vulnerable to physiological instability. To determine the pattern of admission and register outcome of patients in the pediatric high dependency care (PHDC) of Dhaka Shishu( Children) Hospital, a tertiary level referral children hospital in Bangladesh. This is a retrospective study of the record of patients admitted to the PHDC unit at the Dhaka Shishu Hospital from May 2015 to February 2016. The information obtained from the admission/discharge record as well as the patients' case notes included demographic data, working diagnosis, type of management, length of stay (LOS) in the PHDC unit and outcome. A total of 140 children were admitted during the study period comprising of 80 (57.15%) males and 60 (42.85%) females, giving a male: female ratio of 1.33:1. The age ranged from one day to 12 years with a mean of 35.44±3.1 months. Meningitis (both bacterial and viral) accounted for 24 (17.14%) followed by encephalitis, 21 (15%) were the major indications for admission. Other indications included seizure disorders (both febrile and afebrile), 18 (12.85%); bronchopneumonia including acute bronchiolitis, 15 (10.71%); neonates with different indications 13(9.28%); typhoid fever with complications 5 (3.57%); mumps with complications, 4(2.85%); chickenpox with complications, 3(2.14%); surgical conditions, 7 (5%), and others, 30(21.42%). There were no post-operative surgical cases. The length of stay (LOS) in the unit ranged from 1 day to 34 days with mean of 7.9±0.5 days. The treatment expenses ranged from 1000 BDT to 50,000 BDT with a mean of 12297.14±888.69 BDT. Out of total 140 admissions, 82 (58.57%) were discharged in a satisfactory condition; discharge on request (DOR), 30 (21.42%); referred to intensive care unit (ICU), 7 (5%); left against medical advice (LAMA), 15(10.71%) and death, 6 (4.2%); case fatality rate (CFR), 4.2/100 admission. Among the death cases there were 2 meningitis, 2 encephalitis, 1 acute bronchiolitis and 1 preterm very low birth weight (VLBW). Meningitis, encephalitis, bronchopneumonia, seizure disorder were the major causes of admission in PHDC unit, while case fatality was the highest for meningitis and encephalitis. Therefore, awareness regarding prevention, early detection and management of meningitis and encephalitis should be emphasized. CBMJ 2015 July: Vol. 04 No. 02 P: 27-30

scholarly journals Decreased calorie and protein intake is a risk factor for infection and prolonged length of stay in surgical patients: A prospective cohort study

2016 ◽  
Vol 29 (3) ◽  
pp. 307-316 ◽  
Author(s):  
Michelli Cristina Silva de ASSIS ◽  
Carla Rosane de Moraes SILVEIRA ◽  
Mariur Gomes BEGHETTO ◽  
Elza Daniel de MELLO
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Nutritional Therapy ◽  
University Hospital ◽  
Risk Of Infection ◽  
Prolonged Length ◽  
Increased Risk

ABSTRACT Objective The aim was to assess whether postoperative calorie and protein intakes increase the risk of infection and prolonged length of stay in a tertiary care university hospital in Southern Brazil. Methods This is a prospective cohort study approved by the hospital's Research Ethics Committee. The sample consisted of adult patients undergoing elective surgery. The exclusion criteria included patients who could not undergo nutritional assessment and those with a planned hospital stay of fewer than 72 hours. Nutritional status was assessed on admission and every seven days thereafter until hospital discharge or death. Demographic and clinical data, as well as information regarding independent and outcome variables, were collected from the patient's records. Food intake assessment was conducted by researchers six times a week. Calorie and protein intakes were considered adequate if equal to or greater than 75% of the prescribed amount, and length of stay was considered prolonged when above the average for specialty and type of surgery. Data was analyzed using Poisson regression. Results Of the 519 study patients, 16.2% had adequate nutritional therapy. Most of these patients were men with ischemic heart disease and acquired immunodeficiency syndrome. After adjusting for confounders, inadequate nutritional therapy increased risk of infection by 121.0% (RR=2.21; 95%CI=1.01-4.86) and risk of prolonged length of stay by 89.0% (RR=1.89; 95%CI=1.01-3.53). Conclusion Most patients did not have adequate nutritional therapy. Those with inadequate nutritional therapy had a higher risk of infection and longer length of stay.

A descriptive study of adjustment disorder diagnoses in general hospital patients

1994 ◽  
Vol 11 (4) ◽  
pp. 153-157 ◽  
Author(s):  
Paul Foster ◽  
Thomas Oxman
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Adjustment Disorder ◽  
Medical Illness ◽  
Care Hospital ◽  
Psychiatric Admission ◽  
Hospital Patients ◽  
Patient Demographic Data ◽  
One Year ◽  
Descriptive Survey

AbstractObjective: A descriptive survey of the characteristics of medical and surgical patients given the diagnosis of adjustment disorder.Method: 124 case notes of patients with adjustment disorder diagnoses seen over a one year period in a tertiary care hospital were reviewed to describe their characteristics. Patient demographic data, medical illness, hospitalisation details and psychiatric consultation notes were examined.Results: This diagnosis represented 18.5% of consultation-liaison referrals. The length of hospitalisation for the adjustment disorder patients was more than twice that of general medical admissions. At least one psychosocial stressor was noted in 93% of all patients; in 59% of patients the medical illness was one of the stressors noted. About a third of patients had a past psychiatric history. Only 9% of patients had new courses of antidepressants recommended and in only 2% was inpatient psychiatric admission required. The diagnosis was used especially in patients with serious medical conditions, self-harm, injury and poisoning, and in cases presenting with a mixture of somatic and psychic symptoms.Conclusions: The results suggest that this is a commonly used diagnosis in the medical consultation setting; it is largely being used in a way consistent with DSM criteria, whilst there were indications that it was also used for a range of problem behaviours that are difficult to classify.

scholarly journals Evaluation of various antibiotics used in the treatment of cellulitis at a tertiary care hospital

2019 ◽  
Vol 8 (1) ◽  
pp. 272
Author(s):  
Sadiya Mustafavi ◽  
Shafia Siddiqui ◽  
Tanveer Yousra ◽  
Sariya Nooreen ◽  
Sabha Sultana ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Clinical Response ◽  
Tissue Injury ◽  
Demographic Data ◽  
Tertiary Care ◽  
Prolonged Treatment ◽  
Future Research ◽  
Care Hospital ◽  
Microbial Invasion

Background: Cellulitis is an inflammation of the skin and subcutaneous tissues, usually resulting from microbial invasion. It may occur as a result of tissue injury. The mainstay of treatment includes antibiotic therapy based on the susceptibility and severity of infection. The aim of the study is to evaluate various antibiotics used in the treatment of cellulitis at a tertiary care hospital.Methods: Participants were patients referred by Dermatologists, General surgeons with acute and complicated cellulitis. Demographic data, Clinical and biochemical data were analyzed at admission. Then the time taken for improvement of symptoms and length of stay were analyzed.Results: A total of 58 patients were included in the study of which 38(65.5%) patients were male and 20(34.4%) patients were female. Patients having comorbid conditions were found to be having higher length of stay (mean±SD-13.7±3.6 days), severity of infection and antibiotic therapy. Patients with diabetes(mean±SD-16.8±4days) have higher length of stay and slow wound healing. Patients with left leg cellulitis 32(55%) were higher than the right leg cellulitis 17(29%). The reason behind this remains undetermined, which highlights scope for future research in this region.Conclusions: Management of patients was done with mono or dual/combination antibiotic therapy or surgical treatment was done based on clinical response. According to our study patients with co-morbidities especially Diabetes have slow prognosis of cellulitis as they required longer length of stay in a hospital and prolonged treatment. Rational clinical decision on the use of various antibiotics shall be implemented based on evidence-based methods such as iv-to-po shift, regular evaluation of clinical response and stepping down to a narrow-spectrum to reduce the length of stay which can improve the paradigm and the positive clinical response for the management of cellulitis.

scholarly journals Retrospective Analysis of Adult Patients Presenting to the Acute Care Setting Requesting Prescriptions

2021 ◽  
Vol 22 (6) ◽  
pp. 1211-1217
Author(s):  
Lisa Shepherd ◽  
Meagan Mucciaccio ◽  
Kristine VanAarsen
Keyword(s):  
Length Of Stay ◽  
Demographic Data ◽  
Family Doctor ◽  
Opioid Analgesics ◽  
Primary Objective ◽  
Adult Patients ◽  
Urgent Care ◽  
Adverse Health Effects ◽  
Patient Demographic Data ◽  
Canadian City

Introduction: Patient visits to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting prescriptions are challenging for the patient, the physician, and the department. The primary objective of this study was to determine the characteristics of these patients, the nature of their requests, and the response to these requests. Our secondary objective was to determine the proportion of these medication requests that had street value. Methods: This was a retrospective, electronic chart review of all adult patients requesting a prescription from a two-site ED and/or an UCC in a medium-sized Canadian city between April 1, 2014–June 30, 2017. Recorded outcomes included patient demographic data and access to a family doctor, medication requested, whether or not a prescription was given, and ED length of stay. Medication street value was determined using a local police service listing. Results: A total of 2,265 prescriptions were requested by 1,495 patients. The patient median [interquartile range] age was 43 [32-54] years. A family doctor was documented by 55.4% (939/1,694) of patients. The two most commonly requested categories of medications were opioid analgesics 21.2% (481/2,265) and benzodiazepine anxiolytics 11.7% (266/2,265). Of patients requesting medication, 50.5% (755/1,495) requested medications without street value including some with potential to cause serious adverse health effects if discontinued. The requested prescription was received by 19.9% (298/1,495) of patients; 15.3% (173/1,134) returned for further prescription requests. The 90th percentile length of stay was 3.2 and 5.6 hours at the UCC and ED, respectively. Conclusion: Patients who presented to the ED or UCC sought medications with and without street value in almost equal measure. A more robust understanding of these patients and their requests illustrates why a ‘one-size-fits-all’ response to these requests is inappropriate and signals some fault lines within our local healthcare system.

Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis

2019 ◽  
Vol 29 (3) ◽  
pp. 369-374 ◽  
Author(s):  
Andrew M. Koth ◽  
Claudia A. Algaze ◽  
Charlotte Sakarovitch ◽  
Jin Long ◽  
Komal Kamra ◽  
...  
Keyword(s):  
Risk Factor ◽  
Length Of Stay ◽  
Demographic Data ◽  
Univariable Analysis ◽  
Prolonged Length ◽  
Atrioventricular Valve Regurgitation ◽  
Younger Age ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Operative Recovery

AbstractObjectiveThis study sets out to determine the influence of age at the time of surgery as a risk factor for post-operative length of stay after bidirectional cavopulmonary anastomosis.MethodsAll patients undergoing a Glenn procedure between January 2010 and July 2015 were included in this retrospective cohort study. Demographic data were examined. Standard descriptive statistics was used. A univariable analysis was conducted using the appropriate test based on data distribution. A propensity score for balancing the group difference was included in the multi-variable analysis, which was then completed using predictors from the univariable analysis that achieved significance of p<0.1.ResultsOver the study period, 50 patients met the inclusion criteria. Patients were separated into two cohorts of ⩾4 months (28 patients) and <4 months (22 patients). Other than height and weight, the two cohorts were indistinguishable in their pre-operative saturation, medications, catheterisation haemodynamics, atrioventricular valve regurgitation, and ventricular function. After adjusting group differences, younger age was associated with longer post-operative length of hospitalisation – adjusted mean 15 (±2.53) versus 8 (±2.15) days (p=0.03). In a multi-variable regression analysis, in addition to ventricular dysfunction (β coefficient=8.8, p=0.05), Glenn procedures performed before 4 months were independently associated with longer length of stay (β coefficient=−6.9, p=0.03).ConclusionWe found that Glenn procedures performed after 4 months of age had shorter post-operative length of stay when compared to a younger cohort. These findings suggest that balancing timing of surgery to decrease the inter-stage period should take into consideration differences in post-operative recovery with earlier operations.

scholarly journals Average length of stay in Level III and IV Care of Accident and Emergency Department of Tertiary care Hospital

JMS SKIMS ◽  
2011 ◽  
Vol 14 (2) ◽  
pp. 61-62
Author(s):  
Reyaz A Rangrez ◽  
Sheikh Mushtaq ◽  
Shafa Deva ◽  
Tanveer A Rather ◽  
Sameena Mufti ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
Tertiary Care ◽  
Care Hospital ◽  
Emergency Admissions ◽  
Prolonged Length ◽  
Average Length Of Stay ◽  
Accident And Emergency ◽  
Time Gap

BACKGROUND: The scope of Accident and Emergency (A&E) Department is gradually broadening and in fact these are now becoming“mini hospitals within hospitals”.OBJECTIVE:To determine the average length of stay (LOS) in level III and level IV care and factors leading to prolonged length of stay.METHODS:A Hospital based study with follow up of patients received in level III and level IV of A&E Department and the patients were followed till transfer out to respective specialty wards,discharge or death.RESULTS: Emergency beds occupied 9.3% of the total hospital bed strength. Of the total emergency admissions studied, 71.1 % comprised of neurosurgical admissions followed by CVTS (21.4%), neurological (6.8%) and other admissions(1.2%). The average Length of Stay was greatest in CVTS followed by General Surgery i.e. 5.4 days and 4.6 days respectively. The time gap between investigations ordered and reports received was 1.04 days. 67% of the patients who attended A&E Department were of rural background and out of it 54% have read upto high school.CONCLUSIONS: Average Length of stay is 4.3 days which needs to be brought down to 24 hours as per international norms to provide equitable emergency care to wider population. Co-ordination between administration and cliniciansis needed to expedite theproblem.JMS2011;14(2):61-62

scholarly journals Prolonged Length of Stay in the Emergency Department and Mortality in Critically Ill Elderly Patients with Infections: A Retrospective Multicenter Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Wonjin Choi ◽  
Seon Hee Woo ◽  
Dae Hee Kim ◽  
June Young Lee ◽  
Woon Jeong Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Clinical Findings ◽  
Adverse Outcomes ◽  
Prolonged Length ◽  
History Of

Background. This study aimed at investigating whether the length of stay (LOS) in the emergency department (ED) is associated with mortality in elderly patients with infections admitted to the intensive care unit (ICU). Delayed admission to the ICU may be associated with adverse clinical outcomes in elderly patients with infections. Methods. This was a retrospective study conducted with subjects over 65 years of age admitted to the ICU from 5 EDs. We recorded demographic data, clinical findings, initial laboratory results, and ED LOS. Outcomes were all-cause in-hospital mortality and hospital LOS. A multivariable regression model was applied to identify factors predictive of mortality. Results. A total of 439 patients admitted to the ICU via the ED were included in this study, 132 (30.1%) of whom died in the hospital. The median (IQR) age was 78 (73, 83) years. In multivariable analysis, a history of malignancy (OR: 3.76; 95% CI: 1.88–7.52; p < 0.001 ), high lactate level (OR: 1.13; 95% CI: 1.01–1.27; p = 0.039 ), and ED LOS (OR: 1.01; 95% CI: 1.00–1.02; p = 0.039 ) were independent risk factors for all-cause in-hospital admission. Elderly patients with an ED LOS >12 hours had a longer hospital LOS ( p = 0.018 ), and those with an ED LOS > 24 hours had a longer hospital LOS and higher mortality rate ( p = 0.044 ,   p = 0.008 ). Conclusions. This study shows that prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients with infections requiring ICU admission. ED LOS should be considered in strategies to prevent adverse outcomes in elderly patients with infections who visit the ED.

scholarly journals Postoperative Anemia Predicts Length of Stay for Geriatric Patients Undergoing Minimally Invasive Lumbar Spine Fusion Surgery

2020 ◽  
Vol 11 ◽  
pp. 215145932091187
Author(s):  
Ishaan Sachdeva ◽  
Jonathan J. Carmouche
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Geriatric Patients ◽  
Tertiary Care ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Outpatient Setting ◽  
Older Age ◽  
Outcome Variable ◽  
The Impact

Introduction: We hypothesize that postoperative anemia will predict length of stay (LOS) for geriatric patients undergoing minimally invasive (MIS) lumbar spine fusions. Materials and Methods: Patients who underwent MIS lateral and transforaminal lumbar interbody fusion between January 2017 and March 2018 at an academic tertiary care referral center were selected. Eighty-one patients were included. The primary outcome variable was LOS, measured in days. The predictors studied were preoperative hemoglobin (Hgb), postoperative day 1 Hgb, postoperative nadir Hgb, intraoperative Hgb decrement (preoperative Hgb-postoperative day 1 Hgb), perioperative Hgb decrement (preoperative Hgb-postoperative nadir Hgb), age, American Society of Anesthesiologists–Physical Status (ASA-PS) score, volume of perioperative intravenous (IV) fluids (IVFs), and number of levels fused. Simple linear regression and analysis of variance were used for statistical analysis. Results: In the present study, preoperative anemia was not associated with longer LOS ( P = .15). Postoperative anemia was associated with longer LOS as both postoperative day 1 Hgb ( P = .05*) and postoperative nadir Hgb ( P < .0001*) predicted longer LOS. Greater intraoperative Hgb decrement did not predict longer LOS ( P = .36); however, greater perioperative Hgb decrement predicted longer LOS ( P < .0001*). Older age ( P = .01*) and greater number of levels fused ( P = .03*) predicted longer LOS; however, a greater ASA-PS classification did not predict longer LOS. Greater IVF administration was associated with longer LOS ( P < .0001*). Discussion: Postoperative nadir Hgb ( P < .0001*) was more predictive of longer LOS than postoperative day 1 Hgb ( P = .05*). There is a perioperative Hgb decrement associated with longer LOS ( P < .0001*). Geriatric patients may be more susceptible to the potential contributors to Hgb decrement, including occult bleeding post-op and hemodilution from IVF administration. Conclusion: Postoperative anemia, perioperative decrement in Hgb, older age, greater number of levels fused, and greater total IVFs administered predict longer LOS. Understanding the impact of these factors on LOS is critical as these procedures increasingly move to the outpatient setting.

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