length of stay

Incidence, predictors and outcomes associated with acute pulmonary embolism in patients hospitalized with pneumonia: Insights from the National Inpatient Sample

Original Articles, Volume 23, Issue 4, Pages 169– 208 (2024)

Background: The prevalence of acute pulmonary embolism (PE) among patients hospitalized with pneumonia and its association with adverse outcomes remain uncertain.Methods: Data from the US National Inpatient Sample between 2016 to 2020 was used to determine the proportion of patients with chief diagnosis of pneumonia that had concomitant PE and to examine the relationship between...

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A Retrospective Comparison of Emergency Department Throughput Before and After Instituting a Waiting Room Evaluation Process

Original Articles, Volume 23, Issue 3, Pages 97– 168 (2024)

Background: The COVID-19 pandemic has strained the healthcare system with emergency department (ED) boarding and workforce shortages. This prompted the need for strategies to evaluate and treat patients while they waited for an ED room.Objectives: The objective is to describe a waiting room evaluation process and ED throughput in the setting of ED staffing shortages...

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Improving emergency department flow by introducing a simple time out moment (The TRAFFIC LIGHT study)

Original Articles, Volume 23, Issue 1, Pages 1 – 52 (2024)

Background and importance: Long waiting times in the emergency department (ED) is an increasing problem in the recent years and is expected to become an even bigger problem in the future
Objective: We aimed to test the hypothesis whether increasing awareness of the time lapse with the treating physician, 2 hours after patient arrival, can reduce long patient turnaround time (TAT).
Method: In this prospective single-center cohort study we compared and analyzed patient TAT in the ED before and after implementation of a so called ‘traffic light’ moment 2 hours after patient arrival. At this ‘traffic light” moment a team member contacted the treating physician to increased awareness over the time lapse. Difference in percentage of patients who stayed more than 4 hours in the ED before and after intervention was the primary outcome
Results: Between October 2nd 2021 and January 2nd,2022 1494 patients were included for primary outcome analysis. A total of 419 patients (n=740, 56.6%) had a TAT of less than 4 hour in the ED before intervention, compared to 497 (n=754, 65.9%) after intervention (p <0.001). Median time spent in de ED before intervention was 3:40 (IQR 2:24 – 5:04) compared to 3:15 (IQR 2:03 – 4:38) after intervention (p<0.001). Conclusion: This simple and low-cost intervention reduces the ED length of stay significantly. Although multiple interventions will be required to ensure less patients spending more than 4-hours in the ED, a ‘traffic light’ moment can be a simple and an effective tool.

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Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

Background: The incidence of hospital admissions for pulmonary embolism (PE) and associated pleural effusion, and the impact of these effusions on outcomes on a national level is unknown.
Methods: Data from the National Inpatient Sample between 2016 to 2019 was used to conduct a retrospective nationwide cohort study of hospital admissions for PE with and without pleural effusion. Multiple logistic regressions and linear regression analyses were used to determine the independent impact of effusions on in-hospital mortality, length of stay, and cost.
Results: There were 937,744 hospital admissions with PE included in our analysis (median age 64 [interquartile range 50-76] years; 52.5% females). The in-hospital mortality rate overall was 3.7% which was 5.5% for patients with pleural effusion and 3.6% for patients without pleural effusion (p<0.001). The median length of stay was longer in the group with pleural effusion (6 [3-12] days vs 4 [2-6] days, p<0.001) and the median healthcare cost was higher among patients with pleural effusion (13,689 [7,279-30,915] vs 8,855 [5,472-16,531], p<0.001). The factors most associated with pleural effusion were atrial fibrillation (OR 1.89 95%CI 1.78-2.00, p<0.001) and arterial thrombosis (OR 1.48 95%CI 1.19-1.84, p<0.001). Pleural effusion was associated with increased odds of mortality in patients with PE (OR 1.30 95%CI 1.18-1.45, p<0.001). Pleural effusion was associated with increased length of stay (Coefficient 4.15 95%CI 3.99 to 4.32, p<0.001), and healthcare costs (Coefficient 12,164; 95%CI:11,639 to 12,688, p<0.001)). Conclusion: Concomitant pleural effusion is not uncommon among PE patients which is more common in patients with atrial fibrillation and previous arterial thrombosis. Pleural effusions in patients with PE are associated with higher in-hospital mortality, length of stay and cost.

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Length of stay in Acute Medical Admissions: Analysis from the Society for Acute Medicine Benchmarking Audit

Research Audit and Clinical Practice, Volume 21, Issue 1, Pages 1-64 (2022)

Medical admissions to hospital represent a diverse range of patients, from those managed on ambulatory pathways through Same Day Emergency Care (SDEC) services, to those requiring prolonged inpatient admission. An understanding of current patterns of admission through acute medicine services and patient factors associated with longer hospital admission is needed to guide service planning and improvement.

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The evidence for assessing frailty and sarcopenia in an acute medical unit: a systematic review

Clinical Reviews, Volume 20, Issue 1, Pages 1-88 (2021)

Background/objectives: A systematic review was conducted to assess if frailty and sarcopenia were associated with poorer outcomes in older adults admitted to an acute medical unit (AMU).

Methods: Eligible studies included older adults with an unplanned admission to an AMU and included a measure of frailty or sarcopenia, completed within 72 hours of admission. Risk of bias was assessed.

Results: Of 1659 identified articles, 16 were included (4 on sarcopenia and 12 on frailty). There was significant study heterogeneity. Overall, frailty and sarcopenia were associated with worse outcomes. Targeted interventions appeared to improve outcomes.

Conclusion: Current evidence suggests some benefit in screening older adults admitted to an AMU for frailty and sarcopenia. However, further studies are required before clinical adoption.

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Acute Medical Ward for better care coordination of patients admitted with infection – evidence from a tertiary hospital in Singapore

Research Audit and Clinical Practice, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

Coordination and consolidation of care provided in acute care hospitals need reconfiguration and reorganization to meet the demand of large number of acute admissions. We report on the effectiveness of an Acute Medical Ward AMW (AMW) receiving cases that were suspected to have infection related diagnosis on admission by Emergency Department (ED), addressing this in a large tertiary hospital in South East Asia. Mean Length of Stay (LOS) was compared using Gamma Generalized Linear Models with Log-link while odds of readmissions and mortality were compared using logistic regression models. The LOS (mean: 5.8 days, SD: 9.1 days) of all patients admitted to AMW was similar to discharge diagnosis-matched general ward (GW) patients admitted before AMW implementation, readmission rates were lower (15-day: 5.3%, 30-day: 8.1%). Bivariate and multivariate models revealed that mean LOS after AMW implementation was not significantly different from before AMW implementation (Ratio: 0.99, p=0.473). Our AMW had reduced readmission rates for patients with infection but has not made an overall impact on the LOS and readmission rates for the epartment as a whole.

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Predicting length of stay for acute medical admissions using the ALICE score: a simple bedside tool

Research Audit and Clinical Practice, Volume 16, Issue 2, Pages 49 – 100 (2017)

Background: Early identification of patients likely to have a short admission permits best use of limited resources to facilitate rapid discharge where possible. The ALICE score is a simple bedside tool developed in one hospital as a decision aid. This study sought to confirm its widespread applicability.

Method: Retrospective review of 250 consecutive admissions at five acute hospitals. Clinical records were reviewed for a total of 1003 patients. ALICE score was calculated for each patient and compared to LoS data.

Results: There was a statistically significant positive correlation between rising ALICE scores and increasing length of stay irrespective of final diagnoses.

Conclusion: The ALICE score provides a simple bedside tool to predict length of stay.

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Variation in Acute Medicine Units: Measuring it, understanding it, and reducing it

Research Audit and Clinical Practice, Volume 15, Issue 3, Pages 109 – 164 (2016)

Abstract

Although there are national recommendations on the function of Acute Medicine Units (AMUs), there is no single agreed best model of care. Additionally, robust data is not always available to determine whether system changes have resulted in improvement. We designed an Excel file to interface with the hospital patient management system to provide real-time data on a number of metrics including AMU length of stay (AMULOS), mortality and readmissions. This demonstrated that improving consultant continuity of care was associated with a reduction in AMULOS and reduced variation in AMULOS. Additionally, the Excel file provides timely access to consultant and individual patient-level data. These data are clinically owned, and critical for both unit governance and quality improvement work. We would encourage all AMUs to develop a similar dataset to allow standardised comparisons between units, and better understanding of the association between models of care and patient outcomes.

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Profiling the medical admissions of the homeless

Research Audit and Clinical Practice, Volume 11, Issue 4, Pages 193 - 264 (2012)

Abstract

Aim: to describe the characteristics and outcomes of homeless people admitted to our Internal Medicine service in St. James’s Hospital, Dublin (Ireland), between 2002 and 2011.

Methods: we interrogated an anonymized in-patient database.

Results: there were 1,460 homeless admissions (623 unique patients; 39% admitted more than once). Most patients were young, male, and had low comorbidity levels. Thirty-seven percent of the admissions were alcohol-related and 27% substance abuse-related. Thirteen percent had an active psychiatric illness. Their in-patient mortality rate was 5%. Seventy two percent were discharged without the residential arrangement being explicitly documented, 15% self-discharged or absconded, and 8% were discharged to a residential facility.

Conclusion: results are novel in our context and will be relevant for local policy and practice.

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