Factors Affecting Length of Stay for Observation Patients

Dada, Rachel S.; Sule, Anupam A

doi:10.7759/cureus.4547

Cited by 4 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…( 24 ) This study showed that sex is not a predictor of prolonged LOS. This is similar to Mohamed Mosaad ( 25 ), and Dada and Sule ( 26 ) studies. The present study also shows that non-Saudi patients were more likely to experience a prolonged LOS, this is likely due to administrative reasons, as many of these patients require eligibility reviews according to their insurance categories.…”

Section: Discussionsupporting

confidence: 90%

“…This is likely due to the high-prevalence of chronic hematological conditions such as Sickle-cell disease in the Eastern Province of Saudi Arabia which frequently presents to hospital with vaso-occlussive crises requiring hydration & analgesia or fever requiring blood investigations and septic workup. Similarly, a study by Gravel et al found that chronic complex conditions, such as congenital heart disease or cystic fibrosis, had longer LOS in PEDs compared to patients without these conditions ( 30 ) In contrast, several studies have found that respiratory-related complaints were the most common predictive factor for prolonged LOS ( 24 - 26 , 31 ). In the present study, the most common presenting complaint among the prolonged LOS patients were related to respiratory complaints but did not result in a statistically significant increase of their LOS compared to other conditions in the prolonged LOS group.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Factors Affecting Length of Stay in Pediatric Emergency Department in a Teaching Hospital in Saudi Arabia

Yousef,

Qahtani,

Mutairi

et al. 2023

Med Arch

View full text Add to dashboard Cite

Background: Decreasing the number of Emergency Department patient visits for treatment, especially in non-urgent cases, is an international healthcare goal. The same applies for pediatric emergency rooms where the utilization of ED is much more than adults. Objective: We aim to measure the length of stay for all pediatric patients and examine the factors influencing it. Methods: A retrospective chart review study was conducted at the pediatric ED of King Fahd Hospital in the Eastern Province of Saudi Arabia. The study included all patients presented to the pediatric ED, between January 1, 2018, and December 31, 2018, aged from 1 day to < 14 years old. Data included patient’s age, sex, season in which the patient presented in, chief complaint, time of presentation, and whether admission to the hospital ward was collected. Results: The total number of patients was 37,613. The median LOS was 100, interquartile range (IQR) = 53 – 272 minutes. Male pediatric patients were (55.12%). Among all patients, (32.04%) were toddlers, followed by school aged children (25.05%). The ER received more patients during the winter months followed by summer (32.92% and 24.72%, respectively). Fever was the most common complaint for all patients combined. For prolonged LOS patients, the most common complaints were respiratory related (23.44%). Pre-school children and school aged children were found to have a 5.49% and a 7.93% increased LOS when compared to toddlers (95% CI = 2.52 – 8.53, and 95% CI = 5.01 – 10.93, respectively). Summer was associated with a statistically significant increased LOS (% change = 28.92, 95% CI = 25.53 – 32.40). Morning shift was found to have a 7.89% increased LOS when compared to the evening shift. The highest increase in LOS was attributed to haematology related complaints (% change = 108.32, 95% CI = 85.69 – 133.71). Conclusion: Several pediatric LOS predicting factors have been identified; morning arrival, and presentation during summertime. Systemic factors such as staffing, and infrastructure can be modified and may affect the length of stay of patients. The implementation of these strategies and the evaluation of their impact on the length of stay in the pediatric emergency department require further investigation.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 98%

Factors Affecting Length of Stay in Pediatric Emergency Department in a Teaching Hospital in Saudi Arabia

Yousef,

Qahtani,

Mutairi

et al. 2023

Med Arch

View full text Add to dashboard Cite

show abstract

“…Notably, when considering patient volume from 2020 to 2022, our study projected potential cost savings of USD 3116, 8212.50 over three years. These findings align with Dada and Aule's study, which identified factors influencing LOS for observation patients [19]. Our work complements their findings by offering a tangible financial perspective, elucidation how even modest reductions in LOS can yield substantial cost savings and resource optimization.…”

Section: Discussionsupporting

confidence: 89%

The Utilization of 15-Minute Multidisciplinary Rounds to Reduce Length of Stay in Patients under Observation Status

Patel,

Alshami,

Douedi

et al. 2023

Healthcare

View full text Add to dashboard Cite

With the recent change to value-based care, institutions have struggled with the appropriate management of patients under observation. Observation status can have a huge impact on hospital and patient expenses. Institutions have implemented specialized observation units to provide better care for these patients. Starting in January 2020, coinciding with the initiation of daily multidisciplinary rounds, our study focused on patients aged 18 and older admitted to our hospital under observation status. Efforts were built upon prior initiatives at Jersey Shore University Medical Center (JSUMC) to optimize patient care and length of stay (LOS) reduction. The central intervention revolved around the establishment of daily “Observation Huddles”—succinct rounds led by hospital leaders to harmonize care for patients under observation. The primary aim was to assess the impact of daily multidisciplinary rounds (MDR) on LOS, while our secondary aim involved identifying specific barriers and interventions that contributed to the observed reduction. Our study revealed a 9-h reduction in observation time, resulting in approximately USD 187.50 saved per patient. When accounting for the period spanning 2020 to 2022, potential savings totaled USD 828,187.50 in 2020, USD 1,046,062.50 in 2021, and USD 1,243,562.50 in 2022. MDR for observation patients led to a reduction in LOS from 29 h to 20 h (p < 0.001).

show abstract

“…Observational evidence has been published demonstrating the positive impact of observation units on length of stay. [19] Establishing a dedicated observation unit and the standard work associated with its operation is one of the keys to a favorable observation length of stay in the WellSpan Summit Health system. Daily interdisciplinary rounds created a process for sharing UM knowledge to improve the accuracy and efficiency of the level of care determination process.…”

Section: Discussionmentioning

confidence: 99%

Hospital based physician advisor program sheds new light on observation rate

Owolabi

2020

JHA

View full text Add to dashboard Cite

Hospital observation is a topic of interest among patients for whom being classified as observation has negative financial ramifications. Similarly, observation rate is monitored by some hospital administrators because of its potential financial impact on the health system. During the creation of an internal physician advisor program, the new health system physician advisor was asked to investigate causes for a higher than average observation rate for WellSpan Summit Health. Using Lean methodology, standard work was established for the physician advisor observation patient review process when inpatient criteria were not met. Key performance indicators were tracked using production boards and a dashboard that interfaces with the electronic health record. The physician advisor program decreased missed inpatient conversion opportunities, but despite fixing process problems, improving level of care determination accuracy, and seeing outcomes that should have decreased the observation rate, the observation rate paradoxically increased. The cause of the rising observation rate is unknown but is likely multifactorial. Possible causes include changing standards concerning what qualifies as inpatient, Affordable Care Act (ACA) expansion of insured patients presenting to the emergency department (ED) with low acuity conditions, and the safety net function of the hospital for patients living with adverse social determinants of health. The safety net theory is most likely true for “high utilizers” using a greater portion of hospital resources than the rest of the population. This study provides evidence that observation rate is not a useful metric in the absence of a process problem. A more meaningful metric concerning observation patients is observation length of stay.

show abstract

Factors Affecting Length of Stay for Observation Patients

Cited by 4 publications

References 18 publications

Factors Affecting Length of Stay in Pediatric Emergency Department in a Teaching Hospital in Saudi Arabia

Factors Affecting Length of Stay in Pediatric Emergency Department in a Teaching Hospital in Saudi Arabia

The Utilization of 15-Minute Multidisciplinary Rounds to Reduce Length of Stay in Patients under Observation Status

Hospital based physician advisor program sheds new light on observation rate

Contact Info

Product

Resources

About