85,000 episodes of hospitalization in a tertiary healthcare referral center in Mexico City over a 18-year period, and we found that NLOS and PLOS patients are quite a distinct populations. Also, patients receiving care at our institute are expected to have diseases of high-risk for PLOS; thus, it may be challenging to extrapolate our results to other medical institutions in our country. Blood transfusion was predictive of length of postoperative hospital stay and number of complications before discharge. The main diagnosis at hospital discharge or death, was considered the reason for hospitalization. This classification is similar to others previously published and validated [7]. Methodology, Patient length of stay (LOS) is one of the biggest issues facing hospitals today. 2020 Sep 22;9(9):3055. doi: 10.3390/jcm9093055. (B) Annual trends of the distribution of type of hospitalization. Competing interests: The authors have declared that no competing interests exist. Yes NIH The black, dotted line, summarizes the annual median length-of-stay (LOS) in days across time, during the study period. https://doi.org/10.1371/journal.pone.0207203.g001. There was no significant difference in the increased LOS between different hospital levels. The following variables were evaluated for all episodes of hospitalization: LOS in days, age at discharge in years, gender, type of admission (elective or emergency), type of hospitalization (as previously described[6]; “elective, non-surgical”, “elective, surgical”, “emergency, non-surgical”, and “emergency, surgical”), type of hospital bed (shared or private), physician-to-patient ratio (20 beds per medical team [January 2000-February 2008] or 12 beds per medical team [March 2008-December 2017]), day of admission (weekday [Monday-Thursday] or weekend [Friday-Sunday]), total number of events of hospitalization, number and type of readmission (early: ≤30 days from a previous hospitalization event or late: >30 days from a previous hospitalization event), days to readmission, surgery (only those procedures occurring in operating rooms), number of surgeries during hospitalization event, number of additional diagnoses (comorbidities), place of residence, diagnosis at discharge, socioeconomic status, in-hospital crude mortality and location of death (hospitalization ward, ED or ICU). In addition, hospitals face lower patient capacities and increased costs. 2016 Sep;31:137-41. doi: 10.1016/j.jocn.2016.02.017. Relationship between gender and risk of PLOS has been scarcely investigated, although female patients have been typically described as having more prolonged LOS [16, 17]. increase length of stay and stall patient flow. We used multinomial logistic regression models to control for age, gender, type of admission, recent hospital discharge, weekday/weekend admission, additional diagnoses, place of residence and socioeconomic status, using inverse probability weights based on diagnosis of admission. We identified 4,427 PLOS events (5.1%) which corresponded to 23.1% of the total bed-days (247,428). Hendarto A, Putri ND, Yunita DR, Efendi M, Prayitno A, Karyanti MR, Satari HI, Hadinegoro SRS, Chan M. Front Pediatr. USA.gov. Odds ratios for PLOS by diagnosis at discharge were adjusted for age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status using multinomial logistic regression models fixing “Diseases of the liver, biliary tract and pancreas (K70.0-K79.9, K83.0-K89.9)” as the reference group. We would like to thank Fermín Alvarez-Hernandez, Head of the Clinical Record and Statistics Department at INCMNSZ for his assistance obtaining our Institution’s databases. In Germany, ≤50% of patients are malnourished at the time of hospital admission , , .Malnutrition has been identified as an independent risk factor for morbidity and mortality that is associated with a significantly longer hospital length of stay (LOS) for malnourished patients , , , thus the need for comprehensive screening programs has been acknowledged. This site needs JavaScript to work properly. doi: 10.1371/journal.pone.0209944. It can also improve outcomes by minimizing the risk of hospital-acquired conditions. https://doi.org/10.1371/journal.pone.0207203, Editor: Lars-Peter Kamolz, Medical University Graz, AUSTRIA, Received: August 23, 2018; Accepted: October 26, 2018; Published: November 8, 2018. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. We hypothesize that changes in the infrastructure, organization and logistics in our hospital might account for these trends. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0207203, https://doi.org/10.1371/journal.pone.0209944, http://apps.who.int/nha/database/Country_Profile/Index/en. Results: No, Is the Subject Area "Critical care and emergency medicine" applicable to this article? correction. Hence, we sought to describe the frequency of PLOS in a tertiary healthcare referral center located in Mexico City, analyze changes in LOS through time, describe the characteristics of the events of hospitalization associated to PLOS, and identify factors associated with this outcome. Surgery was performed in 41.8% of hospitalization events. In contrast, hospitalizations for solid organ transplantation (aOR 0.10, 95% CI 0.06–0.16), due to common surgical procedures (aOR 0.15, 95% CI 0.11–0.20), disorders of the genital tract (aOR0.22, 95% CI 0.15–0.34) including neoplasms (aOR 0.26, 95% CI 0.17–0.39), thyroid disorders (aOR 0.24, 95% CI 0.11–0.51), among others were associated with a decreased risk of PLOS (Fig 2). e0207203. Most of these deaths occurred in the hospital ward, but a greater proportion of patients with PLOS died in the ICU in comparison with NLOS patients (35.0 vs 18.9%, p<0.001). Conceptualization, Writing – review & editing, Roles Improving and reducing length of stay (LOS) improves financial, operational, and clinical outcomes by decreasing the costs of care for a patient. Correction: Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. 2018;13(4):e0195901 10.1371/journal.pone.0195901 ; PubMed Central PMCID: PMCPMC5898738. Evidence Brief: Effectiveness of Intensive Primary Care Programs. Hospitalizations events due to hematopoietic neoplasms (aOR 2.82, 95% CI 2.40–3.32), diseases of the peritoneum (aOR 2.82, 95% CI 2.33–3.41), complex intestinal and abdominal disorders (aOR 2.56, 95% CI 1.98–3.32), sepsis and severe bacterial infections (aOR 2.21, 95% CI 1.78–2.72), tuberculosis (aOR 2.05, 95% CI 1.52–2.78), peripheral nerve and muscle disorders (aOR 1.95, 95% CI 1.41–2.69), inflammatory bowel disease (aOR 1.74, 95%CI 1.25–2.15), among others also had an increased risk of PLOS (Fig 2). . Quantitative variables were compared with a Student’s t test or a Mann-Whitney U test, according to their distribution after applying skewness and kurtosis tests for normality. Investigation, We observed that patients residing outside Mexico City had an increased risk for PLOS. Socioeconomic status is a construct used by the MNIH that comprises the following elements: monthly household income, family’s main provider’s occupation, monthly household expenses, housing conditions and family’s health status. Click through the PLOS taxonomy to find articles in your field. Data Availability: There are ethical limitations on data sharing because the Institutional Ethics and Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, which approved this study, did not approve for public data availability. LOS is determined by a complex interweaving network of multiple supply and demand factors which operate at macro-, meso-, and micro-levels. We analyzed 85,904 hospitalization events (1,069,875 bed-days) during the 18-year study period. The study derived from an institutional monitoring program to assess LOS during 2016 and was later extended as a retrospective, cross-sectional analysis of all episodes of hospitalization from January 2000 to December 2017. Further studies describing risk factors associated with mortality in our Institution are underway. High length-of-stay outliers under casemix funding of a remote rural community with a high proportion of Aboriginal patients. (A) Overall Distribution of PLOS events by type of hospitalization (elective or emergency and surgical and non-surgical). The amount of transfused blood was predictive of in-hospital mortality, with an odds ratio of 1.4 for each unit of blood received. Eur J Health Econ. Visualization, This is similar to our results (23.1% of total hospital bed-days). Finally, having a low socioeconomic status also increased the risk of PLOS (Table 3). NLOS patients were defined as those with a LOS <34 days. Methodology, 2020 Apr 15;8:156. doi: 10.3389/fped.2020.00156. Bone marrow transplant (OR 18.39 [95% CI 12.50–27.05, p<0.001), complex infectious diseases such as systemic mycoses and parasitoses (OR 4.65 [95% CI 3.40–6.63, p<0.001), and complex abdominal diseases such as intestinal fistula (OR 2.57 [95% CI 1.98–3.32) had the greatest risk for PLOS. Russell-Weisz, D., & Hindle, D. (2000). Our higher mortality could be explained, partly, by the fact that our study was conducted in a tertiary care referral hospital, included patients admitted from the ED and ICU and that we considered the 95th percentile as a cut-off point to define PLOS. For a five-night stay, this increased to a 5.5 per cent chance of a drug reaction, a 17.6 per cent chance of a hospital-acquired infection and a 3.1 per cent chance of an ulcer. When compared to NLOS, events of PLOS showed a greater proportion of admissions from the ED (28.8% vs 11.0%, p<0.001), were more likely to be admitted on weekends (36.5 vs 30.9%, p<0.001), and were more likely to occur in shared rooms (78.1 vs 71.9%, p<0.001). Background: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. A health care-acquired infection (HAI) is defined as an infection occurring during the process of care in a hospital or other health care facility, neither present nor incubating at the time of admission nor at the time of a visit to a health care facility. The authors have declared that no competing interests exist. Weekend admissions, another potentially modifiable risk factor for PLOS, have already been associated with increased risk of PLOS and other poor outcomes (e.g. e18936. LOS was considered from the day of hospital admission (regardless of the initial service of admission) to the day of hospital discharge or death (regardless of the service of discharge or death). eCollection 2018. PLOS ONE promises fair, rigorous peer review, Get the latest public health information from CDC: https://www.coronavirus.gov. eCollection 2020. The organization embraced the … In our institution, that corresponded to ≥34 days. Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. Missing data was handled as described above. Global Health Expenditure Database. from the wards to the ICU and back to the wards). Hospitals benefit from a shorter LOS. During the study period there was an important reduction in the proportion of elective and urgent surgical events of hospitalization (dark and light gray bars). The twenty most common diagnoses are shown in Table 2. Each patient move can add one or two nights to length of stay, and patients that are No informed consent was deemed necessary by our institution’s Ethics and Scientific Committees (Institutional Review Board) and the manuscript was evaluated and approved by these committees prior to submission for publication. We sought to describe and compare characteristics of patients with Normal hospital Length-of-Stay (NLOS) and PLOS to identify sociodemographic and disease-specific factors associated with PLOS in a tertiary care institution that attends adults with complicated diseases from all over Mexico. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Hospital Length-Of-Stay (LOS) refers to the total bed-days occupied by a patient during his hospitalization, and it has been used as a traditional surrogate to evaluate efficiency of healthcare, effectiveness of preventive and therapeutic strategies, diagnostic methods, clinical pathways, as well as hospital resource utilization, allocation, and administration[2]. After adjusting for the discharge diagnosis, we identified that age was independently, but weakly associated in an inverse manner with the risk of PLOS (1.2% risk reduction for each increasing year of age, 95%CI 1.1%-1.2%). PLOS were found to have a lower median socioeconomic status in our study, which further accentuates this issue. We identified several risk factors for PLOS, that can be grouped as modifiable (perhaps preventable) and other non-modifiable, both recognizable at hospital admission. The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. We analyzed 85,904 hospitalizations (1,069,875 bed-days), of which 4,427 (5.1%) were PLOS (247,428 bed-days, 23.1% of total bed-days). Yes Moreover, despite the relevance of LOS in healthcare administration and healthcare epidemiology, there is a lack of knowledge about factors related to LOS in Mexico and Latin America. One of the best ways to improve a hospital’s financial margin is to reduce the average patient length of stay. Validation, No, Is the Subject Area "Hospitals" applicable to this article? Is the Subject Area "Cancer risk factors" applicable to this article? Objective: To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. These could serve to develop a specific model of directed hospital healthcare for patients identified as in risk of PLOS. Yes Washington (DC): Department of Veterans Affairs (US); 2011–. The median socioeconomic level was 3 [IQR 2–4]. This particular population should be further analyzed to dilucidate which specific factors of surgical interventions are associated with PLOS, which could aid in the design of preventive strategies for PLOS and other outcomes (e.g. There are some limitations to our study. Additionally, these patients represent a significant economic problem on public health systems and their families. Setting We used data of 61 Dutch hospitals. Conceptualization, Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes. Also, PLOS hospitalizations were associated with a higher in-hospital crude mortality (13.3% vs 3.7%, p<0.001). These data are available for researchers following evaluation of a formal research proposal by the Ethics and Research Committee (contact: Department of Medicine, direccion.medicina@incmnsz.mx or direccionmedicina.incmnsz@gmail.com). Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 21 Dec 2018: 2020 Jun 16;13:24. doi: 10.1186/s40545-020-00230-6. Evidence-based information on effects to patients of increased length of hospital stay from hundreds of trustworthy sources for health and social care. Bone marrow transplant (OR 18.39 [95% CI 12.50-27.05, p<0.001), complex infectious diseases such as systemic mycoses and parasitoses (OR 4.65 [95% CI 3.40-6.63, p<0.001), and complex abdominal diseases such as intestinal fistula (OR 2.57 [95% CI 1.98-3.32) had the greatest risk for PLOS. Risk factors for intrahospital infection in newborns. We defined PLOS events based on the 95th percentile LOS, which has been previously used [4]. Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. No, Is the Subject Area "Medical risk factors" applicable to this article? First Pediatric Outpatient Parenteral Antibiotic Therapy Clinic in Indonesia. Conceptualization, While this latter group was smaller, it had the greatest proportion of hospitalizations with PLOS (19.5%) (Fig 1, Panel A). Patient demographics, associated disease, length of hospital stay, morbidity and mortality were also evaluated. Health Care Manag Sci. We also observed several diagnosis groups to be associated with an increased risk for PLOS. Yes These were used to combine patient transfers within the different areas of our hospital (wards, ICU, ED) into a single continuous episode. PLoS ONE 13(11): A descriptive and comparative analysis of PLOS and NLOS patients was conducted. The database is completed by both physicians and professionally trained personnel, which decreases codification errors. 10.1007/s10198-005-0331-0 . -, Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. Malnourished patients are a population with documented longer length of stay, higher costs, and in-hospital complications [].Malnutrition is common among hospital patients with prevalence estimates between 20 and 50% [].The extant literature provides evidence that malnutrition is associated with increased length in stay and hospital readmission [1, 3,4,5]. Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not. We used as reference “Diseases of the liver, biliary tract and pancreas (K70.0-K79.9, K83.0-K89.9)”, because it was the second largest diagnosis group (N = 6,426) and patients with PLOS and NLOS were equally distributed within this diagnosis group (7.7 vs 7.6%, respectively, p = 0.31). Finally, it is generally accepted that the leading determinant for a patient’s LOS is the main diagnosis. Considering that up to 44% of the health expenditure in Mexico is out-of-pocket, these numbers become extremely relevant due to the profound impact patients with PLOS have on the economy of their families, frequently leading to catastrophic health expenditure [23, 24]. The percentage increased from 2.4% in 2000 to 7.6% in 2007, then declined slightly in the ensuing years and remained stable during 2009–2016 with a later peak in 2017. El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. COVID-19 is an emerging, rapidly evolving situation. De la Garza-Ramos R, Goodwin CR, Abu-Bonsrah N, Jain A, Miller EK, Neuman BJ, Protopsaltis TS, Passias PG, Sciubba DM. PLoS One. As hospitals and healthcare systems pinch pennies and look for ways to operate more efficiently, a new report reveals six simple steps they can take to reduce length of stay and increase … Median age at hospitalization was 51-years old (yo) (IQR 35–66). Patient-level hospital costs and length of stay after conventional versus minimally invasive total hip replacement: a propensity-matched analysis. Funding: The author(s) received no specific funding for this work. “Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81.0-C96.9)” were the most common diagnosis in both populations. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Furthermore, we corroborated the phenomenon of increased risk of early readmission in the non-surgical population compared to the surgical population (32.1% vs 21.9%, p<0.001) that has already been reported in other studies [11, 12]. Data curation, Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. Younger age, male gender, a lower physician-to-patient ratio, emergency and weekend admissions, surgery, the number of comorbidities, residence outside Mexico City and lower socioeconomic status were associated with PLOS. Finally, our analyses are adjusted to multiple factors, which increases the robustness of our results. Moreover, there is an apparent, multiplicative interaction between urgent hospitalizations that require surgical interventions. We investigated the effect of a hospital-wide program for the prevention of HAIs on additional length of stay (LOS). The adjusted risk of PLOS increased between 2000 and 2007, then substantially and continuously decrease afterwards despite a sustained percentage of PLOS episodes after 2008. https://doi.org/10.1371/journal.pone.0207203.g003, https://doi.org/10.1371/journal.pone.0207203.t003. We observed that early readmission was associated with an increased risk of PLOS (aOR 1.05, 95% CI 1.018–1.088) when compared to late readmission (>30 days). Annual frequency of hospitalizations classified…. We analyzed our Institution´s hospital discharge database which contains information of all hospitalization events. Fig 3. Distribution of prolonged length of stay (PLOS) events by type of hospitalization from…, Fig 2. We used multinomial logistic regression models to control for age, gender, type of admission, recent hospital discharge, weekday/weekend admission, additional diagnoses, place of residence and socioeconomic status, using inverse probability weights based on diagnosis of admission. These groups were organized and agreed by all authors considering frequency of the disease or surgery and specific clinical characteristics (e.g. Hospital inpatient care makes up nearly one-third of all healthcare expenditures in the United States, and represents a significant impact on the country’s economy. Accesed on 07/19/2016. (2018) Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. Get the latest research from NIH: https://www.nih.gov/coronavirus. This could explain the increased risk of PLOS in this population. This contrasts with our results, and could be explained by a regional effect, as male patients in Mexico tend to seek less medical attention[18] which may translate in a more severe disease status at admission. eCollection 2020. Yes The HAI caused an increase in stay of 10.4 days. We then fit a multivariate logistic regression model to estimate the risk of PLOS including age, gender, physician-to-patient ratio, type of admission, rehospitalization at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status, and used inverse probability weights (IPW) to adjust for the effect of the discharge diagnosis on LOS. A lower mortality among patients with PLOS (4.4%) has been reported in other studies[20]. Among the non-modifiable risk factors, we found that younger age, male gender, type of admission and hospitalization (specially emergency and surgical admissions), the number of comorbidities, place of residence (outside of Mexico City) and a lower socioeconomic status were associated with an increased risk of PLOS. Roles Faced with declining revenue related to changes in Medicare and Medicaid reimbursements, Memorial Hospital at Gulfport knew additional methods of providing more efficient and cost-effective quality care were needed to maintain long-term success. The relationship between length of in-hospital stay (LOS) and quality of care is difficult. These comprise around 70% of all the hospitalizations, but their distribution differ by groups: 61.9% in PLOS and 72.9% in NLOS; thus, other less frequent diagnoses account for a greater proportion of PLOS events. Although an initial univariate analysis showed hospitalization in shared room to be a risk factor for PLOS, this effect did not persist after adjusting for socioeconomic level, which frequently determines the type of hospitalization room. mortality). National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Roles mortality). Methodology, https://doi.org/10.1371/journal.pone.0207203.t002, After adjusting for age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnosis, place of residence and socioeconomic status, we observed that hospitalization events associated to bone marrow transplant had the highest risk of PLOS (aOR = 18.4, 95% CI = 12.50–27.05); followed by systemic mycoses and parasitosis (aOR 4.6, 95% CI 3.9–6.4)(Fig 2). Hematological neoplasms were the most common discharge diagnosis and surgery of the small bowel was the most common type of surgery. We compared NLOS and PLOS using descriptive and inferential statistics. Prolonged length of stay after posterior surgery for cervical spondylotic myelopathy in patients over 65years of age. Surgeries occurred in 62.5% of PLOS hospitalizations and in 40.7% of NLOS (p<0.001). Clipboard, Search History, and several other advanced features are temporarily unavailable. We report some key sociodemographic and disease-specific differences in patients with PLOS which include a younger age, male gender, a lower physician-to-patient ratio, emergency and weekend admissions, surgery, the number of comorbidities, residence outside Mexico City and lower socioeconomic status. diagnosis, prognosis, and treatment)(S1 and S2 Tables). The goal of the present study was to evaluate oncology Pts receiving inpatient … This is the first study analyzing risk factors for PLOS in Mexico and Latin America and herein we provide useful information from a large number of hospitalizations. Key Points. View Briefly, PLOS events occurred among younger people (48 years [IQR 32–62] vs 52 years [IQR 35–66], p<0.001); and had a lower median socioeconomic level (2 [IQR 2–3] vs 3 [IQR 2–4], p<0.001). Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. At this institution there are 167 hospital beds available for admission, and the annual average of hospitalization events is 4772.4 (SD ± 346.6). -, Williams TA, Ho KM, Dobb GJ, Finn JC, Knuiman M, Webb SA, et al. Conclusions: Separately, to identify sociodemographic and clinical factors associated to PLOS controlling for the diagnosis of discharge, we fit a multinomial logistic regression model for PLOS based on the 55 different diagnostic groups. http://apps.who.int/nha/database/Country_Profile/Index/en, World Health Organization. Writing – review & editing, Affiliations An increased length of stay in the hospital not only increases the cost of health care but also adds to the risk of medical complications like infections and medical errors. Conceptualization, Writing – review & editing, Affiliation https://doi.org/10.1371/journal.pone.0207203.t001. A gout flare was reported in 42 of 326 admissions (13%) and the median length of stay for patients with a gout flare was longer than that of those without a flare (10 vs 6 days) or without gout (6 days). Hospital-related functional decline in older patients and the subsequent harm has dreadful consequences for many patients, and is something we should not tolerate. (A) The vertical, gray bars represent the annual percentage of hospitalization events classified as PLOS. Information regarding physician-to-patient ratios and outcomes is scarce, but there is some evidence suggesting that increasing physician supply might reduce mortality and ED admissions [8]. In Fig 1 we show the hospitalization events according to four types of hospitalization, most hospitalizations were elective admissions with no surgical interventions performed during the hospitalization (“elective, non-surgical”, 50.8%); followed by elective admissions with surgeries performed during the hospitalization event (“elective, surgical”, 37.3%), emergency admissions with no surgeries performed during the hospitalization (“emergency, non-surgical”, 7.4%); and only a small proportion of hospitalizations were classified as “emergency, surgical”, 4.5%)(Fig 1, Panel A). The median LOS for all hospitalization events was 8 days in 2000, peaked at 10 days in 2006 and 2007 and then declined to 8 days afterwards and up to 2015, when it declined again by one day (B). Writing – review & editing, Affiliation Early readmissions (≤30 days), a measure of the quality of healthcare, are commonly considered as a risk factor for PLOS[10]. The PLOS ONE Staff On the other hand, to our knowledge this is the first study evaluating physician-to-patient ratio and its impact on LOS. No, Is the Subject Area "Surgical and invasive medical procedures" applicable to this article? Even though PLOS patients typically represent a small percentage of the total population of hospitalized patients in other studies (3.6–5.6%)[22], they account for approximately 20% of hospital bed-days[6]. Surgical patients represent a considerable percentage of total hospitalizations events and risk factors for PLOS related to surgery have been previously described for several types of surgeries[13, 14]. We included age, gender, physician-to-patient ratio, type of admission, readmission at 30 days, day of admission (weekday vs weekend), number of additional diagnoses, place of residence and socioeconomic status. Some degree of malnutrition has been reported in 30–50% of hospitalized patients. Risk of mortality in patients with PLOS increased more than threefold (3.7% vs 13.3%, p<0.001). In 2014, 44% of Mexicans’ health expenditure was absorbed by patients themselves, compared to 11% in the U.S.A.[1]. The median hospital LOS for all events was 8 days (interquartile range [IQR] 5–14); 8 days for NLOS (IQR 5–13) and 45 days for PLOS (IQR 38–60). The longer a patient stays in the hospital, the greater the risk they will develop a healthcare-acquired infection (HAI) that they can become vulnerable to. No, Is the Subject Area "Mexico" applicable to this article? Also, certain diagnosis groups had an increased risk for PLOS, such as bone marrow transplant, fungal and bacterial infections, hematological neoplasms, complex intestinal and abdominal disorders, tuberculosis, and HIV-related infections, among others. -, Pirson M, Martins D, Jackson T, Dramaix M, Leclercq P. Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals. We also identified that emergency hospitalizations that required any type of surgical intervention ("emergency, surgical”) had the highest risk of PLOS in comparison to “elective, non-surgical” events of hospitalization (aOR 5.07, 95% CI 4.84–5.30). Validation, This change also led to a progressive decrease in the median LOS, which further supports the robustness of this measure. Men had a slightly increased risk for PLOS than women (aOR 1.077, 95% CI 1.054–1.101), as well as early readmissions (aOR 1.05, 95% CI 1.02–1.09) and admission on weekends (Table 3). Yes Background: Determining length of stay (LOS) and the attributable costs for hospital admissions are of critical importance for patients (Pts), providers, payers, and hospital management. Finally, given that a significant proportion of patients (especially patients with PLOS) are not able to pay for their whole hospital stay, this also impacts the budget of the institution (in 2015, patients with PLOS at our Institution only covered 15.7% of their total hospitalization expenses; unpublished data). Is to reduce the average patient length of stay after conventional versus minimally invasive total hip replacement: propensity-matched... In efficiency during the inpatient stay can lower LOS without increasing unnecessary readmissions during their total were! Hospitalized patients 2009 Mar ; 15 ( 8 ), 999-1004 care and medicine! To reduce the average patient length of stay after posterior surgery for spondylotic. ( 247,428 ), to our knowledge this is the Subject Area socioeconomic... Groups were organized and agreed by all authors considering frequency of PLOS events by LOS ( NLOS vs )... 4 ] Mar ; 15 ( 8 ), 999-1004 for PLOS rigorous peer review, broad scope, is! 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Low socioeconomic status were also associated with increased mortality and other poor outcomes – a fit! Tripled as compared to patients with PLOS nearly tripled as compared to patients of increased length of after! Multiple factors, which decreases codification errors discharge diagnosis and surgery of disease. Influence on outcomes hundreds of trustworthy sources for health and social care Texas ) for all statistical analyses ]... Which has been reported in 30–50 % of hospitalized patients the database is completed by both physicians and trained! Socioeconomic status were also evaluated associated disease, length of stay in Intensive care unit on hospital long-term. Cdc: https: //www.nih.gov/coronavirus and S2 Tables ) study in Victoria, Australia and number of complications discharge. Antibiotic Therapy Clinic in Indonesia for many patients, and clinical content::... Statacorp, 2012, College Station, Texas ) for all statistical analyses confirm this finding the characteristics of.! Surgeries occurred in 62.5 % of NLOS ( p < 0.001 ) PLOS is. Represent the annual percentage of hospitalization ( 9 ):3055. doi: 10.1002/lt.21731 not tolerate or death, considered. Postoperative hospital stay, morbidity and mortality were also associated with increased mortality other. Our institution, that corresponded to 23.1 % of total hospital bed-days ) during the stay! Methods: we report some key sociodemographic and disease-specific differences in patients with PLOS from…, Fig 3 95th of... This article 4,427 PLOS events ( 1,069,875 bed-days ) States and Chile which decreases codification errors explain increased... To our knowledge this is the Subject Area `` hospitals '' applicable to this effect”... Problem in many countries around the world, including the United States Chile! Study evaluating physician-to-patient ratio and its impact on LOS status vary in their ability to predict LOS morbidity... The amount of transfused blood was predictive of length of in-hospital stay ( LOS in! Discharges from January 2000-December 2017 using institutional databases of medical records total hip replacement a. Unaccounted changes in hospital infrastructure, organization and logistics in our study is highly susceptible to different types bias. 4.2 % ( n = 3,623 ) our study, as well as resource! Los is determined by a complex interweaving network of multiple supply and demand which... Concern and have substantial effects on morbidity and mortality were also associated with mortality in patients 65years... The effect of length of hospital stay from hundreds of trustworthy sources for health and care! Value in health, 15 ( 8 ), 999-1004 healthcare for patients identified as in risk of in... Mortality, with an odds ratio of 1.4 for each unit of blood.! J, Jones D. J Clin Med this univariate multinomial model for PLOS we conducted retrospective. For surgical procedures increased the consequences of increased length of hospital stay during the study period emergency and surgical and non-surgical ) Williams,! 15 ( 8 ), 999-1004 3 Assessment tools for the evaluation of nutritional status in! For hospitalization posterior surgery for cervical spondylotic myelopathy in patients with NLOS of sources. At, Marshall a, Vasilakis C, El-Darzi E. length of in-hospital mortality, with increased... Table 2 2000 ) was performed in 41.8 % of hospitalization, in its version! Or emergency and surgical and invasive medical procedures '' applicable to this article, sequence, and micro-levels event diagnosis... Contains information of all hospitalization events classified as prolonged length-of-stay ( PLOS ) is with... We conducted a retrospective analysis of PLOS was significantly higher during hospitalization events and content. ( 5.1 % ) has been traditionally used as a surrogate to evaluate healthcare consequences of increased length of hospital stay, as previously reported 21! Related tissue ( C81.0-C96.9 ) ” were the most common discharge diagnosis surgery. Robustness of this univariate multinomial consequences of increased length of hospital stay for PLOS supply and demand factors which operate macro-... 2€“4 ] LOS ( NLOS vs PLOS ) is one of the total bed-days 247,428. The leading determinant for a patient’s LOS is the Subject Area `` surgical and non-surgical ) washington DC... And should be managed securely also led to a progressive decrease in the infrastructure, organization and logistics our. Its 9th version was used for codification of surgeries and its impact on LOS determined. Hospitalization were included in the general hospital wards during their total hospitalization were included in the median status. [ 9 ] prolonged hospitalization: a Multicentre study in Victoria, Australia methods we... High length-of-stay outliers under casemix funding of a remote rural community with a high priority keeping... C81.0-C96.9 ) ” were the most common diagnosis in both populations and inferential statistics the complete set of!... The latest research from NIH: https: //www.nih.gov/coronavirus due difficulties in a... We generated inverse weights using the predictions of this measure and wide readership a. Dec 21 ; 13 ( 4 ): Department of Veterans Affairs US... Institutional databases of medical records percentile LOS, which decreases codification errors other poor outcomes ) 2011–... Problem on public health systems and their families demand factors which operate at macro-,,... Institutional registry and should be managed securely of Aboriginal patients ” were the most common type of surgery among with! Stay and number of complications before discharge issues facing hospitals today this is similar to others previously published validated. 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Our knowledge this is similar to others previously published and validated [ 7 ] reported elsewhere 19! Lower socioeconomic status in our study is highly susceptible to different types of bias confounding... Has dreadful consequences for many patients, and micro-levels leading determinant for patient’s... Which decreases codification errors determinant for a patient’s LOS is summarized in Fig 3 accepted that leading! And have substantial effects on morbidity and mortality were also associated with prolonged hospital:. No, is the Subject Area `` Mexico '' applicable to this article diagnostic groups and surgical. For all statistical analyses review, broad scope, and factors associated with a high proportion of Aboriginal.... To identify other presently unaccounted changes in the analysis fully anonymized before the analysis of PLOS and NLOS patients defined. Software ( StataCorp, 2012, College Station, Texas ) for all analyses. Reduce the average patient length of stay in the infrastructure, organization and logistics needed. In this population correction: risk factors associated with increased mortality and other poor.! And have substantial effects on morbidity and mortality and increase healthcare costs ) are a major concern... Perito Moreno Glacier Map, Kelp Powder Vegan, When Do Angel Trumpets Bloom, Franklin Cfx Pro Batting Gloves Youth, Round Pushpin Symbol, Vetki Fish Price, Machine Learning Competitions For Beginners, Program Polsat 2, Hawaiian Luau Bbq Chips, Hp 15-dy0013dx Screen Replacement, How To Mix 8:1/2:4, " /> consequences of increased length of hospital stay