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

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.

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Disability Impacts Length of Stay in General Internal Medicine Patients

Journal of General Internal Medicine ◽

10.1007/s11606-014-2815-z ◽

2014 ◽

Cited By ~ 1

Author(s):

Chunzhen Tan ◽

Yee Sien Ng ◽

Gerald C. H. Koh ◽

Deidre A. De Silva ◽

Arul Earnest ◽

...

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

General Internal Medicine ◽

General Internal

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A Comparison of Hours Length of Stay and Compliance with 24-Hour Patient Length of Stay Between Emergency and General Internal Medicine/Internal Medicine Subspecialty Observation Services: Implication for ED Crowding at a Tertiary Care Center

Academic Emergency Medicine ◽

10.1197/j.aem.2007.03.925 ◽

2007 ◽

Vol 14 (5 Supplement 1) ◽

pp. S80-S81 ◽

Cited By ~ 1

Author(s):

F. Khan ◽

M. Faulk ◽

A. Hertlein

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

General Internal Medicine ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

General Internal ◽

Ed Crowding

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Infectious Diseases on a General Internal Medicine Clinical Teaching Unit

Canadian Journal of Infectious Diseases ◽

10.1155/1999/571053 ◽

1999 ◽

Vol 10 (1) ◽

pp. 33-38

Author(s):

LE Nicolle ◽

J Uhanova ◽

P Orr ◽

A Kraut ◽

K Van Ameyde ◽

...

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

Infectious Diseases ◽

General Internal Medicine ◽

Clinical Teaching ◽

Cost Of Care ◽

Therapeutic Interventions ◽

General Internal ◽

Teaching Unit ◽

Time Of Admission

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.

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

BMJ Quality & Safety ◽

10.1136/bmjqs-2013-002289 ◽

2013 ◽

Vol 23 (6) ◽

pp. 446-456 ◽

Cited By ~ 17

Author(s):

Finlay A McAlister ◽

Jeffrey A Bakal ◽

Sumit R Majumdar ◽

Stafford Dean ◽

Rajdeep S Padwal ◽

...

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

General Internal Medicine ◽

Controlled Study ◽

General Internal ◽

Inpatient Length Of Stay

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Does Reducing Inpatient Length of Stay Have Upstream Effects on the Emergency Room: Exploring the Impact of the General Internal Medicine Care Transformation Initiative

Academic Emergency Medicine ◽

10.1111/acem.12935 ◽

2016 ◽

Vol 23 (6) ◽

pp. 711-717 ◽

Cited By ~ 6

Author(s):

Finlay A. McAlister ◽

Jeffrey A. Bakal ◽

Rhonda J. Rosychuk ◽

Brian H. Rowe

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

Emergency Room ◽

General Internal Medicine ◽

General Internal ◽

The Impact ◽

Inpatient Length Of Stay

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The outpatient assessment of patients with anemia by a general internal medicine service

Journal of Hospital Administration ◽

10.5430/jha.v6n3p41 ◽

2017 ◽

Vol 6 (3) ◽

pp. 41

Author(s):

H. McFadgen ◽

S. Couban ◽

S. Doucette ◽

A. Kreuger-Naug ◽

S. Shivakumar

Keyword(s):

Internal Medicine ◽

Chronic Disease ◽

Iron Deficiency ◽

General Internal Medicine ◽

Iron Deficiency Anemia ◽

Deficiency Anemia ◽

General Internist ◽

Anemia Of Chronic Disease ◽

General Internal ◽

Number Of Patients

At the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, 2,400-2,800 new outpatient referrals for hematology consultation are received annually and approximately 10% of these referrals are specifically for isolated anemia. In recent years, such referrals have been sent from hematology to general internal medicine (GIM) for assessment and management. A retrospective chart review was conducted of a cohort of 99 patients from 2013 to describe the demographics, assessment, management and outcome of these patients, as well as to inform whether this practice should continue. The median age of patients was 60.3 years (min 19.4, max 97.6) and 62% were female. The median hemoglobin level was 109.0 g/L (min 66, max 137) at the time of referral and the median wait time was 53 days (min 8 days, max 171 days). Pearson’s correlation analysis revealed that those with lower hemoglobin levels were seen more quickly. The patients had an additional 2.8 comorbidities on average, and were significantly more likely to receive non-anemia related adjustment to care with increasing number of comorbidities. A small proportion of patients (n = 5, 5.1%) were referred from GIM back to hematology, whereas 21% were referred to gastroenterology. A small number of patients (n = 5, 5.1%) underwent a bone marrow aspirate and biopsy. The most common diagnoses identified in the initial clinic letters were iron deficiency anemia (n = 59, 59.6%) and anemia of chronic disease (n = 8, 8.1%). 26.3% did not have a diagnosis identified. These findings support our practice to have patients with an isolated anemia evaluated by a general internist rather than a hematologist. Most of these patients had iron deficiency anemia or the anemia of chronic disease and received additional care for their comorbid conditions in the GIM clinic. Further work will help to define how such patients can be most effectively assessed and treated.

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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.

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Effect of A Brief Education On The Occupational History Taking In Hypertension Patients

Acta Medica ◽

10.32552/2018.actamedica.324 ◽

2018 ◽

Vol 49 (4) ◽

pp. 1-5

Author(s):

Seval Müzeyyen Ecin ◽

Adem Koyuncu ◽

Abdulsamet Sandal ◽

Sultan Pınar Çetintepe ◽

Nursel Çalık Başaran ◽

...

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Outpatient Clinic ◽

Occupational Diseases ◽

History Taking ◽

University Hospitals ◽

Occupational History ◽

General Internal ◽

Number Of Patients ◽

Significant Difference

Objective: This study is designed to measure the effect of 10-minutes training about occupational diseases, history taking and relation of occupation and hypertension on occupational history taking rates of physicians. Materials and Methods: This research is conducted between 01 April 2018 to 31 May 2018 at Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of General Internal Medicine Outpatient Clinic. The training including the importance and methods of taking occupational history, and the relation between occupation and diseases is given to the new assistant doctor group as an extra 10 minutes’ education session. At the end of May, researchers screened electronic medical files of patients who diagnosed with hypertension (ICD10 code I10) of outpatients in General Internal Medicine Division in April and May 2018. Results: We reviewed the data of 3619 adult patients administered to General Internal Medicine Outpatient Clinic of Hacettepe University Hospitals in between 01 April to 31 May 2018. A total of 395 (10.9%) patients had hypertension diagnosis code. The total number of patients whose occupational history taken were 151 (38.2%). There were statistically significant difference between physician groups not trained in April and trained 10 minutes in May, 62 (32%), and 89 (44.3%), respectively (p:0.012). Among the hypertensive patients whose occupational history were recorded, 36 (23.8%) had an occupation. Conclusion: This result emphasizes the importance of education in raising awareness of taking an occupational history. As occupational diseases are 100% preventable diseases, taking occupational history will enhance the diagnosis and effective treatment of the occupational or work-related diseases. Beginning from the medical faculty lectures, seminars and post-graduate education have to be added and increased regarding this important issue. Keywords: Occupational history, occupational disease, hypertension.

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