Waiting it out: consultation delays prolong in-patient length of stay

BackgroundDecreasing delays for hospitalised patients results in improved hospital efficiency, increased quality of care and decreased healthcare expenditures. Delays in subspecialty consultations and procedures can cause increased length of stay due to reasons outside of necessary medical care.ObjectiveTo quantify, describe and record reasons for delays in consultations and procedures for patients on the general medicine wards.MethodologyWe conducted weekly audits of all admitted patients on five Internal Medicine teams over 8 weeks. A survey was reviewed with attending physicians and residents on five internal medicine teams to identify patients with a delay due to consultation or procedure, quantify length of delay and record reason for delay.ResultsDuring the study period, 316 patients were reviewed and 48 were identified as experiencing a total of 53 delays due to consultations or procedures. The average delay was 1.8 days for a combined total of 83 days. Top reasons for delays included scheduling, late response to page and a busy service. The frequency in length of consult delays vary among different specialties. The highest frequency of delays was clustered in procedure-heavy specialties.ConclusionThis report highlights the importance of reviewing system barriers that lead to delayed service in hospitals. Addressing these delays could lead to reductions in length of stay for inpatients.

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Clinical, behavioural and social factors associated with racial disparities in COVID-19 patients from an integrated healthcare system in Georgia: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-044052 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044052

Author(s):

Felipe Lobelo ◽

Alan Bienvenida ◽

Serena Leung ◽

Armand Mbanya ◽

Elizabeth Leslie ◽

...

Keyword(s):

Quality Of Care ◽

Racial Disparities ◽

Clinical Outcomes ◽

Healthcare System ◽

Retrospective Cohort ◽

Chronic Obstructive ◽

Integrated Healthcare ◽

Icu Admission ◽

Hospitalised Patients

ObjectivesTo identify sociodemographic, clinical and behavioural drivers of racial disparities and their association with clinical outcomes among Kaiser Permanente Georgia (KPGA) members with COVID-19.DesignRetrospective cohort of patients with COVID-19 seen from 3 March to 29 October 2020. We described the distribution of underlying comorbidities, quality of care metrics, demographic and social determinants of health (SDOH) indicators across race groups. We also described clinical outcomes in hospitalised patients including length of stay, intensive care unit (ICU) admission, readmission and mortality. We performed multivariable analyses for hospitalisation risk among all patients with COVID-19 and stratifyied by race and sex.SettingKPGA, an integrated healthcare system.Participants5712 patients who all had laboratory-confirmed COVID-19. Of them, 57.8% were female, 58.4% black, 29.5% white, 8.5% Hispanic and 3.6% Asian.ResultsBlack patients had the highest proportions of living in neighborhoods under the federal poverty line (12.4%) and in more deprived locations (neighbourhood deprivation index=0.4). Overall, 14.4% (n=827) of this cohort was hospitalised. Asian patients had the highest rates of ICU admission (53.1%) and mechanical ventilation (21.9%). Among all patients, Hispanics (adjusted 1.60, 95% CI (1.08, 2.37)), blacks (1.43 (1.13, 1.83)), age in years (1.03 (1.02, 1.04)) and living in a zip code with high unemployment (1.08 (1.03, 1.13)) were associated with higher odds of hospitalisation. COVID-19 patients with chronic obstructive pulmonary disease (2.59 (1.67, 4.02)), chronic heart failure (1.79 (1.31, 2.45)), immunocompromised (1.77 (1.16, 2.70)), with glycated haemoglobin >8% (1.68 (1.19, 2.38)), depression (1.60 (1.24, 2.06)), hypertension (1.5 (1.21, 1.87)) and physical inactivity (1.25 (1.03, 1.51)) had higher odds of hospitalisation.ConclusionsBlack and Hispanic KPGA patients were at higher odds of hospitalisation, but not mortality, compared with other race groups. Beyond previously reported sociodemographics and comorbidities, factors such as quality of care, lifestyle behaviours and SDOH indicators should be considered when designing and implementing interventions to reduce COVID-19 racial disparities.

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Abstract 3023: The Association of Insurance Status, Quality of Care, and In-Hospital Outcomes among Patients Hospitalized with Intracerebral Hemorrhage: Findings from GWTG-Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3023 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Michael L James ◽

Julian P Yand ◽

Maria Grau-Sepulveda ◽

DaiWai M Olson ◽

Deepak L Bhatt ◽

...

Keyword(s):

Quality Of Care ◽

Length Of Stay ◽

Intracerebral Hemorrhage ◽

Reference Group ◽

Private Insurance ◽

Quality Measures ◽

Geographic Region ◽

Insurance Status ◽

Hospital Outcomes

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.

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Chest tube removal after cardiac surgery

Critical Care Nurse ◽

10.4037/ccn1997.17.1.34 ◽

1997 ◽

Vol 17 (1) ◽

pp. 34-38 ◽

Cited By ~ 6

Author(s):

SC Thomson ◽

S Wells ◽

M Maxwell

Keyword(s):

Cardiac Surgery ◽

Quality Of Care ◽

Length Of Stay ◽

Chest Tube ◽

Chest Tubes ◽

Tube Removal ◽

Chest Tube Removal

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

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