Safely and effectively reducing inpatient length of stay: a controlled study of the General Internal Medicine Care Transformation Initiative

OBJECTIVE: To describe the spectrum of infectious diseases and characteristics of patients admitted with infections on a general internal medicine clinical teaching unit.DESIGN: Retrospective review of patients admitted to one general internal medicine unit at a tertiary care teaching hospital during two three-month periods.METHODS: Data collection through chart review.OUTCOME MEASURES: Descriptive analysis of types of infections: therapeutic interventions; consultations and outcomes, including death; hospital-acquired infection; and length of stay.RESULTS: During the two three-month periods, 76 of 233 (33%) and 52 of 209 (25%) admissions were associated with a primary diagnosis of infection. An additional 23 (10%) and 24 (12%) patients had infection at the time of admission, but this was not the primary admitting diagnosis. Pneumonia, urinary infection, and skin and soft tissue infection were the most frequent diagnosis at the time of admission, but these accounted for only about 50% of admissions with infection. Patients admitted with infection were characterized by a younger age, greater number of therapeutic interventions in the first 24 h, and increased medication costs, entirely attributable to antimicrobial therapy, but patients admitted with infection did not differ in comorbidity, death, nosocomial infection or length of stay compared with patients without infection.CONCLUSIONS: A wide variety of infections contribute to admissions to general internal medical clinical teaching units. Patients with infection have more interventions and an increased cost of care, but do not differ in outcome.

Download Full-text

Effect of an Intervention to Improve Team Coordination on Patients Who are Likely to be Discharged by General Internal Medicine

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v10i1.21 ◽

1970 ◽

Vol 10 (1) ◽

Author(s):

Lina Pham BA ◽

Teri Arany ◽

William Coke MD ◽

Vivian Lo ◽

Robert C. Wu MD

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

Length Of Stay ◽

General Internal Medicine ◽

Discharge Planning ◽

Teaching Hospitals ◽

Post Discharge ◽

General Internal ◽

Effective Discharge ◽

The Impact

Effective discharge planning is important to ensuring a high quality of patient care and operational efficiency. The general internal medicine (GIM) environment is very complex and fluid, with multiple health professions providing care for patients. This makes coordination of discharges difficult, even with structured daily interprofessional rounds.The purpose of this case-control study was to evaluate a discharge notification form that predicts next-day discharges. The main measures of the study, which took place in GIM wards at two academic teaching hospitals, were the completion and accuracy of the discharge forms, length of stay, discharge times, post-discharge admissions, and emergency department visits.Seventy-six of 200 patients studied had information completed on the discharge notification form. The overall effect appeared to move discharges earlier in the day, while having no effect on length of stay.Patients whose information was completed on the discharge notification form were less likely to have an emergency department visit within 30 days post-discharge.The use of a discharge notification form appears to move discharges earlier in the day, without increasing length of stay. Further refinement and evaluation is necessary to increase usage and assess the impact onoutcomes of care.

Download Full-text

Morning Discharges and Patient Length of Stay in Inpatient General Internal Medicine

Journal of Hospital Medicine ◽

10.12788/jhm.3605 ◽

2021 ◽

Vol 16 (6) ◽

Author(s):

Abirami Kirubarajan ◽

Saeha Shin ◽

Michael Fralick ◽

Janice Kwan ◽

Lauren Lapointe-Shaw ◽

...

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

Hospital Mortality ◽

General Internal Medicine ◽

Patient Flow ◽

Situational Factors ◽

General Internal ◽

Number Of Patients ◽

Improve Patient ◽

Multivariable Adjustment

BACKGROUND: Many initiatives seek to increase the number of morning hospital discharges to improve patient flow, but little evidence supports this practice. OBJECTIVE: To determine the association between the number of morning discharges and emergency department (ED) length of stay (LOS) and hospital LOS in general internal medicine (GIM). DESIGN, SETTING, AND PARTICIPANTS: Multicenter retrospective cohort study involving all GIM patients discharged between April 1, 2010, and October 31, 2017, at seven hospitals in Ontario, Canada. MAIN MEASURES: The primary outcomes were ED LOS and hospital LOS, and secondary outcomes were 30-day readmission and in-hospital mortality. The number of morning GIM discharges (defined as the number of patients discharged alive between 8:00 am and 12:00 pm ) on the day of each hospital admission was the primary exposure. Multivariable regression models were fit to control for patient characteristics and situational factors, including GIM census. RESULTS: The sample included 189,781 patient admissions. In total, 36,043 (19.0%) discharges occurred between 8:00 am and 12:00 pm . The average daily number of morning discharges and total discharges per hospital was 1.7 (SD, 1.4) and 8.4 (SD, 4.6), respectively. The median ED LOS was 14.5 hours (interquartile range [IQR], 10.0- 23.1), and the median hospital LOS was 4.6 days (IQR, 2.4-9.0). After multivariable adjustment, there was not a significant association between morning discharge and hospital LOS (adjusted rate ratio [aRR], 1.000; 95% CI, 0.996-1.000; P = .997), ED LOS (aRR, 0.999; 95% CI, 0.997-1.000; P = .307), 30-day readmission (aRR, 1.010; 95% CI, 0.991-1.020; P = .471), or in-hospital mortality (aRR, 0.967; 95% CI, 0.920-1.020; P = .183). The lack of association between morning discharge and LOS was generally consistent across all seven hospitals. At one hospital, morning discharge was associated with a 1.9% shorter ED LOS after multivariable adjustment (aRR, 0.981; 95% CI, 0.966-0.996; P = .013). CONCLUSIONS: The number of morning discharges was not significantly associated with shorter ED LOS or hospital LOS in GIM. Our findings suggest that increasing the number of morning discharges alone is unlikely to substantially improve patient throughput in GIM, but further research is needed to determine the effectiveness of specific interventions.

Download Full-text