scholarly journals Can medical admission and length of stay be accurately predicted by emergency staff, patients or relatives?

2007 ◽  
Vol 31 (4) ◽  
pp. 633 ◽  
Author(s):  
Andrew W Dent ◽  
Tracey J Weiland ◽  
Lisa Vallender ◽  
Nicola E Oettel
Keyword(s):  
Length Of Stay ◽  
Vital Signs ◽  
Prediction Tool ◽  
Short Stay ◽  
Reasonable Accuracy ◽  
Appropriate Use ◽  
Medical Assessment ◽  
Convenience Sample ◽  
Emergency Admissions ◽  
Medical Symptoms

Objectives: To determine the accuracy of predictions of the need for hospital admission and, if admitted, length of stay (LOS) made early in an emergency attendance by emergency department (ED) doctors, nurses, patients and relatives, and the characteristics of ED presentations predictive of admission and short stays (~3 days). Methods: Prospective collection of predictions by medical and nursing staff, patients and relatives of ED departure status and LOS (1 day, 2-3 days, 4- 7 days or longer) of a convenience sample of adults presenting with medical symptoms. Predictions were made before full medical assessment and matched against actual departure status and LOS. Vital signs and demographics were recorded. Results: Seventy five percent (2159/2904; CI 73%?77%) of all admission predictions in 704 patients were correct with 85% (575/673; CI 81%- 88%) of doctors? predictions correct. Thirty-five percent (361/1024) of all LOS predictions for 331 patients were correct with 46% (122/268; CI 40%- 52%) of doctors? predictions correct. Risk factors for short-stay over longer admission included age less than 65, normal oxygen saturations and selfreferral. Conclusion: Emergency admissions can be predicted with reasonable accuracy but LOS is difficult to predict. Development of a prediction tool may facilitate streaming and appropriate use of short-stay units.

Length of Stay, Short Stay Units and Psychiatric Emergency Admissions

1989 ◽  
Vol 34 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Brian Baker ◽  
James Rochon
Keyword(s):  
Length Of Stay ◽  
Metropolitan Area ◽  
Psychiatric Emergency ◽  
Short Stay ◽  
General Hospitals ◽  
Emergency Admissions ◽  
Total Length ◽  
Major Metropolitan Area ◽  
One Year

Length of stay information was collected from 1,364 individuals over a one year period for five general hospitals in a major metropolitan area. The current set of data represents homogeneity in the nature of admissions and the type of facilities examined. Three of the hospitals operated short stay units. Significant differences in the total length of stay were observed according to age, sex and presence of psychosis but there were no unequivocal distinctions between short stay and conventional hospitals.

scholarly journals Impact of the level of sickness on higher mortality in emergency medical admissions to hospital at weekends

2017 ◽  
Vol 22 (4) ◽  
pp. 236-242 ◽  
Author(s):  
Mohammed Mohammed ◽  
Muhammad Faisal ◽  
Donald Richardson ◽  
Robin Howes ◽  
Kevin Beatson ◽  
...  
Keyword(s):  
Early Warning ◽  
Odds Ratio ◽  
Vital Signs ◽  
Early Warning Score ◽  
Emergency Admissions ◽  
Clinical Assessments ◽  
Admission Time ◽  
Emergency Medical ◽  
Acute Hospitals ◽  
National Early Warning Score

Objective Routine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time. Results Emergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p < 0.001) with a higher mortality (weekend: 706/11,332 6.23% vs. weekday: 2039/35,785 5.70%; odds ratio = 1.10, 95% CI 1.01 to 1.20, p = 0.04) which was no longer seen after adjusting for the index National Early Warning Score (odds ratio = 0.99, 95% CI 0.90 to 1.09, p = 0.87). Index National Early Warning Score was recorded sooner (−0.45 h, 95% CI −0.52 to −0.38, p < 0.001) for weekend admissions. Conclusions Emergency medical admissions at the weekend with electronic National Early Warning Score recorded within 24 h are sicker, have earlier clinical assessments, and after adjusting for the severity of their sickness, do not appear to have a higher mortality compared to weekday admissions. A larger definitive study to confirm these findings is needed.

scholarly journals The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Steve Turner ◽  
Edwin-Amalraj Raja
Keyword(s):  
Hospital Admissions ◽  
Geographic Region ◽  
Health Board ◽  
Short Stay ◽  
Emergency Admissions ◽  
Inpatient Ward ◽  
Assessment Unit ◽  
Stay Hospital ◽  
Clinical Referral ◽  
Health Boards

Abstract Background Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay (also called zero day) admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions. Methods Details of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians. Results SSPAUs opened in 7 health boards, between 2004 and 2012. Health boards with an SSPAU had a slower rise in zero day admissions compared to those without SSPAU (0.6% per month [95% CI 0.04, 0.09]. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened. Conclusion Opening an SSPAU has heterogeneous outcomes on the proportion of zero day admissions in different settings. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.

Abstract P83: Predictors of Length of Stay for HF Patients: Results from Get With the Guidelines

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
David J Whellan ◽  
Xin Zhao ◽  
Adrian F Hernandez ◽  
Eric D Peterson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Length Of Stay ◽  
Vital Signs ◽  
P Value ◽  
Chi Square ◽  
Unit Increase ◽  
History Of ◽  
Multivariable Regression ◽  
Get With The Guidelines

Background: Heart failure (HF) admissions are frequent and result in significant expenditures. Identifying predictors of increased length of stay (LOS), particularly above the median LOS, may help providers set expectations for patients and target resources effectively. Methods: We analyzed HF admissions (n= 70,094) from January 2005 through April 2007 from 246 hospitals in the AHA's Get With The Guidelines-HF program. In a subset with BNP (n=44,535), baseline characteristics, admission vital signs and selected labs (BNP, creatinine, BUN, hemoglobin, and sodium) were included in a multivariable regression analysis to determine factors associated with LOS ≥4 days. Results: Patients were median age of 72, 45% female, 53% had ischemic etiology, and median LVEF was 35%. Median LOS was 4 days (25 th ,75 th 2,6). The most significant predictors of LOS ≥ 4 days were a higher admission BUN, higher heart rate, and lower SBP (Table 1). Age, insurance, race, creatinine, and LVEF were not. Conclusion: Upon admission for HF, certain vital signs, comorbidites, and laboratory values are associated with an increased likelihood of a LOS ≥ 4 days. These observations may be of value in the implementation of interventions aimed at reducing LOS and improving quality of care in HF. Variables Associated With Hospital LOS >/= 4 Days Variable Chi-Square OR Lower (95% CI) Upper (95% CI) P-value Admissioun BUN (/1 unit increase) 221.8 1.01 1.01 1.01 <.001 Admission SBP (/ 10-unit increase) 129.6 0.96 0.95 0.96 <.001 Heart Rate (/ 10-unit increase) 122.4 1.07 1.06 1.09 <.001 History of COPD/Asthma 45.8 1.19 1.13 1.25 <.001 Admission BNP (per 100-unit increase) 37.6 1.01 1.00 1.01 <.001 Female vs. Male 29.7 1.12 1.08 1.17 <.001 History of renal insufficiency 27.4 1.17 1.10 1.24 <.001 History of heart failure 18.0 0.89 0.85 0.94 <.001 Region: (MW vs. NE)
 (S vs NE)
 (W vs. NE) 17.3 0.71
 0.91
 0.71 0.60
 .077
 0.56 0.85
 1.08
 0.88 <.001

scholarly journals Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

2019 ◽  
Vol 24 (03) ◽  
pp. e313-e318
Author(s):  
Sidhartha Sinha ◽  
Matthew Fok ◽  
Ijaz Ahmad ◽  
Mustafa Al-Sheikh ◽  
Christopher Backhouse
Keyword(s):  
Patient Education ◽  
Length Of Stay ◽  
District General Hospital ◽  
Unplanned Readmission ◽  
Short Stay ◽  
Retrospective Audit ◽  
Parathyroid Adenomas ◽  
Biochemical Cure ◽  
Postoperative Length ◽  
Preoperative Patient

Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas.The length of stay decreased from a median of 3 days (range 2–9 days; mean 3.32) preprotocol to a median of 2 days (range 2–3 days; mean 2.16) postprotocol (p < 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p = 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

scholarly journals Factors affecting length of stay in Children Hospital in Southern Iran

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tayebeh Baniasadi ◽  
Kobra Kahnouji ◽  
Nasrin Davaridolatabadi ◽  
Saeed Hosseini Teshnizi
Keyword(s):  
Length Of Stay ◽  
Diagnostic Procedures ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Emergency Admissions ◽  
Factors Affecting ◽  
Proportional Allocation ◽  
Hospital Resources ◽  
Attending Physician ◽  
Time Of Admission

Abstract Background One of the effective indicators for determining the efficiency and optimal use of hospital resources is the length of stay (LOS). This study aimed to determine the patients’ length of stay and the factors affecting the LOS in the Children’s hospital. Method A cross-sectional study was performed on Children Hospital medical record database including 350 records (April 2015 to Dec 2015). Records were selected by stratified random sampling with proportional allocation. Then the predetermined demographic and hospital variables were extracted through the study of patients’ medical records. All statistical analysis were performed using SPSS software. Results The overall median of the LOS in the studied hospital was 3 days (IQR =3). The results showed that in this hospital the LOS has a significant relationship with the variables of time of admission, the place of residence, type of admission, and the degree of attending physician. Also, with the increasing number of visits, ultrasonography, counseling and laboratory test, LOS was increased. Conclusion Improving processes related to diagnostic procedures, providing adequate staffing for specialized services in all hours of the day, preventing unnecessary and non-emergency admissions in the evening and night, will be effective in optimizing patient LOS.

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