Assessing the causes inducing lengthening of hospital stays by means of the Appropriateness Evaluation Protocol

Identifying reasons for delays in acute hospitals using the Day-of-Care Survey method

“…These vary, possibly refl ecting the different international models of health and social care. For example in a study from Belgium, 8 the most frequent reasons were 'waiting for an examination (investigation)' (22%) and 'lack of extra-hospital structures' (31%). A French study 7 stated nonavailability of 'outside' care or resources accounted for 61% of the reasons for inappropriate stays in medical units and 83% of surgical stays (68% overall).…”

“…[4][5][6] The criteria have also been shown to reliably identify acuity of medical illness and, in one study, the presence of positive AEP criteria refl ected increased morbidity and mortality. 5 Since 1981, the AEP criteria have been used, or modifi ed for local use, in Italy, 6 France, 7 Belgium, 8 Holland, 9 Spain, 10,11 Germany, 12 Denmark 5 and Turkey. 13,14 Assessments in the UK include the 1997 national study of acute medical admissions conducted by the Royal College of Physicians of London, 4 which reviewed 4,885 days of hospital care against the AEP criteria.…”

Fifty ways to reduce length of stay: An inventory of how hospital staff would reduce the length of stay in their hospital

“…And in addition treating patients in a joint care programme [42,43] • Surgical pre-assessment, planning the admission, post-operative care and planning a safe discharge [44], early imaging with CT, MRI, or nuclear scintigraphy, particularly on the day before or the day of admission [45] • Preventing admissions of patients not needing inpatient care [46][47][48] • Utilising specialised nurse practitioners or other advanced professionals [49][50][51] • Creating an observation unit that gives more time to decide whether or not to admit the patient [52] • Stimulating that patients initially are seen by the right specialty [53] • Performing same-day major surgery [47] • Optimising guidelines and protocols or introducing clinical pathways for specific patient groups in order to reduce the length of stay and often with improvements of quality of care • Treating patients in a fast-track or accelerated care programme [54][55][56][57][58][59][60][61][62] • Choosing a laparoscopic rather than a classic intervention (open surgery) [63][64][65][66][67][68][69][70] although readmission rates for laparoscopic treatment may be higher [71] • Implementing an acute stroke unit [72] • Being aware that consultations, transfers and fragmentation of care often lead to delays [73,74] • Reducing waiting times for examinations [8,48] • Stimulating early rehabilitation and physical activity [75]…”

“…If all Dutch hospitals were as efficient as the benchmark hospitals, then a total gain of at least 1.8 million hospital days, or 14% of all hospital days, would have been attainable for 2006 [4]. The inter-hospital variation in length of stay is still substantial -even after standardising for case-mix -not only in the Netherlands, but also in other countries [5][6][7][8][9][10][11].…”

Length of stay as risk factor for inappropriate hospital days: interaction with patient age and co‐morbidity

“…Population ageing, which is associated with chronic illness, is likely to result in a shift of the economic burden of care for the elderly from the hospital to the long‐term care sector, with consequences for the supply, organization and funding of both sectors [2]. Current evidence suggests that inappropriate use of acute care hospital beds for such patients is still frequent [3]. Home care provision is often insufficient for the chronically ill, and a significant portion of inappropriate hospital days is known to be due to delays in the transfer of such patients to long‐term care facilities [4].…”