For more information about PLOS Subject Areas, click However, patients referred from other hospitals (frequently outside Mexico City), with diseases that require more complex diagnostic workup or therapeutic approach. During each event of hospitalization, patients could be transferred several times to different areas of the hospital depending on their clinical status (e.g. Increased LOS can sometimes be due difficulties in coordinating a safe and timely discharge plan. Investigation, Risk of mortality in patients with PLOS increased more than threefold (3.7% vs 13.3%, p<0.001). 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]. 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. Methodology, Distribution of prolonged length of stay (PLOS) events by type of hospitalization from…, Fig 2. Recent research suggests that improvements in efficiency during the inpatient stay can lower LOS without increasing unnecessary readmissions. We identified 4,427 PLOS events (5.1%) which corresponded to 23.1% of the total bed-days (247,428). Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. These groups were organized and agreed by all authors considering frequency of the disease or surgery and specific clinical characteristics (e.g. 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). Categorical variables were compared using the chi-squared test. e18936. J Pharm Policy Pract. HHS 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. The organization embraced the … The modifiable risk factors include: physician-to-patient ratio and, potentially, the day of admission (weekday vs weekends). eCollection 2020. Materials and methods: No, Is the Subject Area "Critical care and emergency medicine" applicable to this article? We used multiple chained equations to impute missing data with 10 imputations. Results: 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). We also include the calendar-year in our model, and show the adjusted odds ratios for PLOS per calendar-year in Fig 3, Panel B, where we can observe that the adjusted risk of PLOS increases sharply between 2003 and 2007 in comparison to 2000, and then decreased afterwards in such degree of magnitude that the adjusted odds ratio of PLOS is lower in any calendar-year after 2012 in comparison to 2000. Elective hospitalization events for surgical procedures increased the most during the study period. Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients. 10.1007/s10198-005-0331-0 . https://doi.org/10.1371/journal.pone.0207203.g001. Additionally, these patients represent a significant economic problem on public health systems and their families. 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. Yes 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. 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. 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]. Evidence-based information on effects to patients of increased length of hospital stay from hundreds of trustworthy sources for health and social care. No, Is the Subject Area "Hospitals" applicable to this article? (A) The vertical, gray bars represent the annual percentage of hospitalization events classified as PLOS. We generated inverse weights using the predictions of this univariate multinomial model for PLOS. Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals. Funding: The author(s) received no specific funding for this work. 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. Conceptualization, Fig 1. Our hospital, a public tertiary healthcare referral center located in Mexico City, is one of the Mexican National Institutes of Health (MNIH) and provides healthcare to adult patients with complex diseases from all over the country. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. 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. For more information about PLOS Subject Areas, click These patients are typically admitted in a more critical condition and have a high mortality; we found a mortality of 8.4% for those admitted through the ED vs 3.7% for those admitted directly to the wards (p<0.001). Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Roles We defined PLOS events based on the 95th percentile LOS, which has been previously used [4]. The HAI caused an increase in stay of 10.4 days. No, Is the Subject Area "Cancer detection and diagnosis" applicable to this article? WHY LENGTH OF STAY MATTERS. Methodology, Ensuring the delivery of appropriate care and treatment is crucial for quality of care; length of stay in hospital may be irrelevant to this process. Data curation, The relationship between length of in-hospital stay (LOS) and quality of care is difficult. -, 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. Diagnoses and surgeries were classified in groups for analysis (55 diagnostic groups and 30 surgical groups). We report some key sociodemographic and disease-specific differences in patients with PLOS. One of the best ways to improve a hospital’s financial margin is to reduce the average patient length of stay. Validation, The black, vertical, boxplots illustrate the annual adjusted odds ratios (aORs) for prolonged stay of hospitalization (PLOS) using 2000 as the year of reference. Missing data was handled as described above. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. We excluded hospitalization events that were exclusively managed in the Emergency Department [ED], in the Intensive Care Unit [ICU] or both (N = 5,441). Writing – original draft, Validation, Median age at hospitalization was 51-years old (yo) (IQR 35–66). In 2014, 44% of Mexicans’ health expenditure was absorbed by patients themselves, compared to 11% in the U.S.A.[1]. 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). Eur J Health Econ. 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]. Visualization, The black, dotted line, summarizes the annual median length-of-stay (LOS) in days across time, during the study period. In our study, in-hospital crude mortality in patients with PLOS nearly tripled as compared to patients with NLOS. 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). 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. Moreover, the median time for readmission was shorter in PLOS hospitalizations, both for early (11 vs 13 days, p<0.001) and late (201 vs 261 days, p<0.001) readmissions. 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). Global Health Expenditure Database. We hypothesize that changes in the infrastructure, organization and logistics in our hospital might account for these trends. 2020 Sep 22;9(9):3055. doi: 10.3390/jcm9093055. The goal of the present study was to evaluate oncology Pts receiving inpatient … A lower mortality among patients with PLOS (4.4%) has been reported in other studies[20]. Liver Transpl. Only events that included at least one day of stay in the general hospital wards during their total hospitalization were included in the analysis. 2005;8(3):213–20. PLoS One. This classification is similar to others previously published and validated [7]. Yes Importantly, we also observed important changes in the frequency of PLOS over time and the adjusted risk of PLOS, during the study period, which are more noticeable before and after 2007, when the trend in increased frequency of PLOS and adjusted risk of PLOS over time, reversed significantly. A descriptive and comparative analysis of PLOS and NLOS patients was conducted. Hospitalizations in shared rooms have been reported to increase the risk of PLOS[15], but we did not observed this phenomenon in our population. Moreover, there is an apparent, multiplicative interaction between urgent hospitalizations that require surgical interventions. Visualization, 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. Validation, Copyright: © 2018 Marfil-Garza et al. 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). Visualization, Yes Conceptualization, Further investigations to identify other presently unaccounted changes in hospital infrastructure, organization and logistics are needed to better characterize this observation. Annual frequency of hospitalizations classified as prolonged length-of-stay (PLOS) from 2000–2017. Discover a faster, simpler path to publishing in a high-quality journal. 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