A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service
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BACKGROUND: Delays in the care of hospitalized patients may lead to increased length of stay, iatrogenic complications, and costs. No study has characterized delays among general medicine inpatients in the current prospective payment era of care.
OBJECTIVE: To quantify and characterize delays in care which prolong hospitalizations for general medicine inpatients.
DESIGN: Prospective survey of senior residents.
SETTING: Urban tertiary care university-affiliated teaching hospital.
PARTICIPANTS: Sixteen senior residents were surveyed regarding 2,831 patient-days.
MEASUREMENTS AND MAIN RESULTS: Data were collected on 97.6% (2,762) of patient-days eligible for evaluation. Three hundred seventy-three patient-days (13.5% of all hospital days) were judged unnecessary for acute inpatient care, and occurred because of delays in needed services. Sixty-three percent of these unnecessary days were due to nonmedical service delays and 37% were due to medical service delays. The vast majority of nonmedical service delays (84%) were due to difficulty finding a bed in a skilled nursing facility. Medical service delays were most often due to postponement of procedures (54%) and diagnostic test performance (21%) or interpretation (10%), and were significantly more common on weekend days (relative risk [RR], 1.49; P=.02). Indeed, nearly one fourth of unnecessary patient-days (24% overall, 88 patient-days) involved an inability to access medical services on a weekend day (Saturday or Sunday).
CONCLUSIONS: At our institution, a substantial number of hospital days were judged unnecessary for acute inpatient care and were attributable to delays in medical and nonmedical services. Future work is needed to develop and investigate measures to decrease delays.
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- Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality, and costs. J Am Geriatr Soc. 2003;51:364–70. CrossRef
- Shojania KG, Duncan BW, McDonald KM, Wachter RM. Safe but sound: patient safety meets evidence-based medicine. JAMA. 2002;288:508–13. CrossRef
- Centers for Medicare and Medicaid Services. US Health Care System. Available at: http://www.cms.hhs.gov/charts/default.asp. Accessed January 2004.
- Selker HP, Beshansky JR, Pauker SG, Kassirer JP. The epidemiology of delays in a teaching hospital. Med Care. 1989;27:112–29. CrossRef
- Brasel KJ, Rasmussen J, Cauley C, Weigelt JA. Reasons for delayed discharge of trauma patients. J Surg Res. 2002;107:223–6. CrossRef
- Gertman PM, Restuccia JD The appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care. Med Care. 1981;19:855–71. CrossRef
- The InterQual Review System. Marlborough, MA: InterQual Products Group; 1996.
- The Managed Care Appropriateness Protocol. Wellesley, MA: Oak Group; 1996.
- Baigelman W, Weld L, Coldiron JS. Relationship between practice characteristics of primary care internists and unnecessary hospital days. Am J Med Qual. 1994;9:122–8.
- McDonagh MS, Smith DH, Goddard M. Measuring appropriate use of acute beds: a systematic review of methods and results. Health Policy. 2000;53:157–84. CrossRef
- D’Addario V, Curley A. How case management can improve the quality of patient care. Int J Qual Health Care. 1994;6:339–45. CrossRef
- Evans RL, Hendricks RD. Evaluating hospital discharge planning: a randomized clinical trial. Med Care. 1993;31:358–70. CrossRef
- Tennier LD. Discharge planning: an examination of the perceptions and recommendations for improved discharge planning at the Montreal General Hospital. Soc Work Health Care. 1997;26:41–60. CrossRef
- Halpert AP, Pearson SD, LeWine HE, Mckean SC. The impact of an inpatient physician program on quality, utilization, and satisfaction. Am J Manag Care. 2000;6:549–55.
- Palmer HC, Armistead NS, Elnicki DM, et al. The effect of a hospitalist service with nurse discharge planner on patient care in an academic teaching hospital. Am J Med. 2001;111:627–32. CrossRef
- Davis KM, Koch KE, Harvey JK, Wilson R, Englert J, Gerard PD. Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system. Am J Med. 2000;108:621–6. CrossRef
- Varnava AM, Sedgwick JE, Deaner A, Ranjadayalan K, Timmis AD. Restricted weekend service inappropriately delays discharge after acute myocardial infarction. Heart. 2002;87:216–9. CrossRef
- Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001;345:663–8. CrossRef
About this Article
- A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service
Journal of General Internal Medicine
Volume 20, Issue 2 , pp 108-115
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- hospital care
- quality improvement
- length of stay
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- Author Affiliations
- 1. Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- 2. Division of Nephrology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA