Hospital length of stay and probability of acquiring infection

Hassan, M. Kabir; Tuckman, Howard P.; Patrick, Robert H.; Kountz, David S.; Kohn, Jennifer L.

doi:10.1108/17506121011095182

Cited by 96 publications

(55 citation statements)

References 25 publications

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“…LOS is an important metric of quality of healthcare provision as it is often associated with complications occurring within the hospital. [30][31][32] Further reasons why medical outlying patients may experience longer LOS include the delayed medical contact between arrival and first examination in the case the patient was placed straight away on an 'inappropriate' ward, insufficient contact with medical and nursing personnel during outlying period, and also inability of nursing personnel to meet patient needs because of lack of specialisation on the disease/condition of the patient. The field of medical outliers is not extensively researched, although evidence does exist to suggest that being in the right bed at the right time is beneficial to patients, as a number of studies in stroke, burns, asthma and gastrointestinal haemorrhage have shown.…”

Section: Discussionmentioning

confidence: 99%

Are medical outliers associated with worse patient outcomes? A retrospective study within a regional NHS hospital using routine data

2017

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ObjectiveTo explore the quality and safety of patients’ healthcare provision by identifying whether being a medical outlier is associated with worse patient outcomes. A medical outlier is a hospital inpatient who is classified as a medical patient for an episode within a spell of care and has at least one non-medical ward placement within that spell.Data sourcesSecondary data from the Patient Administration System of a district general hospital were provided for the financial years 2013/2014–2015/2016. The data included 71 038 medical patient spells for the 3-year period.Study designThis research was based on a retrospective, cross-sectional observational study design. Multivariate logistic regression and zero-truncated negative binomial regression were used to explore patient outcomes (in-hospital mortality, 30-day mortality, readmissions and length of stay (LOS)) while adjusting for several confounding factors.Principal findingsUnivariate analysis indicated that an outlying medical in-hospital patient has higher odds for readmission, double the odds of staying longer in the hospital but no significant difference in the odds of in-hospital and 30-day mortality. Multivariable analysis indicates that being a medical outlier does not affect mortality outcomes or readmission, but it does prolong LOS in the hospital.ConclusionsAfter adjusting for other factors, medical outliers are associated with an increased LOS while mortality or readmissions are not worse than patients treated in appropriate specialty wards. This is in line with existing but limited literature that such patients experience worse patient outcomes. Hospitals may need to revisit their policies regarding outlying patients as increased LOS is associated with an increased likelihood of harm events, worse quality of care and increased healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Are medical outliers associated with worse patient outcomes? A retrospective study within a regional NHS hospital using routine data

2017

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“…Such a bias dampens the measured effect and its statistical significance. Shorter hospital stays among the intervention patients : The shorter LOS among the intervention patients lowers the probability of hospital acquired infections and diseases—an additional day in the hospital was found to increase the probability of infections by 1.37 percent (Hassan et al. ). …”

Section: Discussionmentioning

confidence: 99%

Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes

Mukamel

Amin

Weimer

et al. 2016

Health Services Research

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Objective To test whether use of a personalized report card, Nursing Home Compare Plus (NHCPlus), embedded in a reengineered discharge process, can lead to better outcomes than the usual discharge process from hospitals to nursing homes. Data Sources/Setting Primary data collected in the Departments of Medicine and Surgery at a University Medical Center between March 2014 and August 2015. Study Design A randomized controlled trial in which patients in the intervention group were given NHCPlus. Participants included 225 patients or their family members/surrogates. Data Collection Key strokes of NHCPlus users were recorded to obtain information about usage. Users were surveyed about usability and satisfaction with NHCPlus. All participants were surveyed at discharge from the hospital. Survey data were merged with medical records. Principal Findings About 85 percent of users indicated satisfaction with NHCPlus. Compared to controls, intervention patients were more satisfied with the choice process (by 40 percent of the standard deviation p < .01), more likely to go to higher ranked five‐star nursing homes (OR = 1.8, p < .05), traveled to further nursing homes (IRR = 1.27, p < .10), and had shorter hospital stays (IRR = 0.84, p < .05). Conclusions Personalizing report cards and reengineering the discharge process may improve quality and may lower costs compared to the usual discharge process.

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“…Standardized policies are one of the key features of the quality, innovation, productivity, prevention (QIPP) program, which has the objective to enhance the management of operations in the NHS (British Medical Association, 2010). The motivation behind this decision is that empirical evidence suggests a positive relationship between length of stay and risk of hospital-acquired infections (HAIs) (Hassan, Tuckman, Patrick, Kountz, & Kohn, 2010;Mitchell & Gardner, 2012). The motivation behind this decision is that empirical evidence suggests a positive relationship between length of stay and risk of hospital-acquired infections (HAIs) (Hassan, Tuckman, Patrick, Kountz, & Kohn, 2010;Mitchell & Gardner, 2012).…”

Section: Introductionmentioning

confidence: 99%

On the tension between standardized and customized policies in health care: The case of length‐of‐stay reduction

Catena

Dopson

Holweg

2019

J of Ops Management

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Hospitals increasingly adopt standardized policies as a way to improve the efficiency of health care delivery. One key policy has been to reduce a patient's length of stay, which is commonly perceived as an effective means of improving patient outcome, as well as reducing the cost per procedure. We put this notion to the empirical test by using a database of 183,712,784 medical records of patients in the English NHS between 1998 and 2012, studying the effects of the NHS's policy of decreasing length of stay for hernia patients. While we found it to be an effective way of reducing the cost per procedure, on aggregate, we also found that it increases the risk of readmission and of death for vulnerable and elderly patients, unduly increasing the long‐term failure costs of the operation for these patient groups. Based on our findings, we propose a differentiated policy to selectively decrease length of stay, which we estimate could save up to US$565 per nonemergency hernia procedure (19.97% reduction in the cost per procedure). We outline the implications of our findings for medical practice and discuss the wider theoretical contributions to the wider standardization‐customization debate in health care operations management.

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Hospital length of stay and probability of acquiring infection

Cited by 96 publications

References 25 publications

Are medical outliers associated with worse patient outcomes? A retrospective study within a regional NHS hospital using routine data

Are medical outliers associated with worse patient outcomes? A retrospective study within a regional NHS hospital using routine data

Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes

On the tension between standardized and customized policies in health care: The case of length‐of‐stay reduction

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