Patients’ Length of Stay: Key Factors

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Table of Contents

Introduction
The Negativity of LOS
Delaying Surgery and LOS
Inter-Hospital Transfer: The Acceptance from Another Hospital and LOS
Intra-Hospital Transfer: Delaying from Another Department and LOS
Late Rounds by Doctors
Conclusion
References

Introduction

Forecasting and monitoring a patient’s hospital stay is a valuable strategic approach for healthcare resource management and high-quality treatment delivery. Murai et al. (2021) state that patients’ length of stay (LOS) generally refers to a patient’s confinement in a healthcare facility, which can fluctuate from one patient to another depending on many factors. The paper addresses the negative aspects of LOS and how delaying surgery or acceptance from another hospital may impact the length of stay. Furthermore, the relationship between delaying from another hospital department and discharge and the implications of the LOS on late rounds by doctors are discussed.

The Negativity of LOS

Hospitals may face severe resource constraints, and the length of stay of patients has a detrimental influence on the quality of care. According to Rahman et al. (2022), controlling the LOS is significantly more critical in the least developed and developing nations, where healthcare resources are sparse and administrative processes are primarily manual. Nonetheless, resource optimization and patient flow management are increasingly highly diverse and complicated concerns in hospitals. Predicting patients’ LOS may play a critical role in fulfilling the expanding healthcare demand by enhancing the utilization of healthcare resources (Rahman et al., 2020). Wang et al. (2020) argue that reducing the length of a patient’s stay in the hospital is one of the most successful strategies for the effective management of hospital resources during times of crisis, as well as a significant step to improving the healthcare service quality. In such cases, predicting the length of a patient’s stay in the hospital can make the hospital management system more efficient.

Thus, LOS control results in higher hospital profitability, as well as allowing physicians and other healthcare professionals to handle the patient flow. More extended hospital stays are linked to higher infection risks, depressed moods, and lower motivation, which can impact a patient’s health after release and raise the likelihood of readmission (Delayed transfers of care: a quick guide, 2018). Hospitals are nevertheless required to provide resources and personnel to care for patients who have a prolonged stay in the hospital, even when they may not need the same rigorous degree of clinical care (Delayed transfers of care: a quick guide, 2018). Patients and employees in the health and care system should be concerned about care transfers that are delayed.

Delaying Surgery and LOS

Delaying surgery may prolong the patient’s length of stay significantly. Mujagic et al. (2018) acknowledge that in comparison to same-day surgery, several investigations have revealed that preoperative length of stay is inherently linked to a higher risk of surgical site infections. Infectious problems and increased delays in elective coronary artery bypass grafts, colectomies, and lung resections were shown to be correlated (Mujagic et al., 2018). Surgery patients frequently face the risk of surgical site infections (SSI), which can occur in up to five percent of people who have surgery, despite several measures taken to avoid them. SSIs are linked to higher morbidity and death rates (Mujagic et al., 2018). Additionally, they are known to lengthen hospital stays, which critically affects health care expenses.

Inter-Hospital Transfer: The Acceptance from Another Hospital and LOS

The acceptance from another hospital for transferring increases the length of stay; patient transfers between hospitals are referred to as inter-hospital transfers (IHT). Mueller et al. (2019) emphasize that IHT frequently happens, exposing patients to hazards of care discontinuity, such as communication failures and information transfer deficiencies. For instance, considering the severity of the disease in this patient population and the lack of additional elements to close communication gaps, including standard electronic health records, patients experiencing IHT may even be more sensitive to these hazards than patients undergoing other care transitions. Mueller et al. (2019) demonstrate that regardless of illness type, all transferred patients had higher allowable charges, daily costs, and longer LOS for the total acute care period. Patients who had been transferred often had a lower likelihood of being sent home than patients who had not been moved (Muller et al., 2019). Therefore, IHT is linked to increased resource utilization, including higher permitted costs, longer LOS, and lower rates of discharge home.

Intra-Hospital Transfer: Delaying from Another Department and LOS

Delaying from another department in the hospital makes the discharge longer. Gu et al. (2021) acknowledge that the definition of an intra-hospital transfer is a patient move within the same facility for any diagnostic treatment. Even though intra-hospital transfers happen daily, they can endanger patients’ lives and expose them to risk. The intra-hospital transfers result in problems, poorer results, a more significant workload for the personnel, and higher healthcare expenses (Gu et al., 2021). The issue is exacerbated by unneeded transfers, delays, and time wasted during transfers. Gu et al. (2021) state that transfer delays can be brought on by poor communication, a shortage of beds and equipment, a problem with staffing assignments, and a delay in updating records and information. Therefore, ineffective intra-hospital transfer increase patient mortality and hospital duration of stay.

Late Rounds by Doctors

Ward rounds led by doctors are essential to provide patients with the best care possible. Hence, ward systems and processes must be created with efficiency and safety at their core to optimize the patient journey (Carpenter et al., 2019). The intensive medical assessment unit is a particular setting where patients are continuously admitted and discharged, necessitating practically constant senior evaluation and decision-making (Carpenter et al., 2019). Additionally, it has been suggested that evening ward rounds may be specifically successful in an acute admission environment in identifying suitable patients for potential early discharge. Carpenter et al. (2019) assert that there is some evidence that ward rounds do decrease the average patient LOS on medical and surgical wards. Nevertheless, a high level of work intensity might cause burnout and harm the clinical service’s efficacy (Carpenter et al., 2019). Thus, unnecessary LOS negatively impacts doctors, patients, and healthcare.

Conclusion

To conclude, a patient’s confinement in a healthcare facility is referred to as their length of stay (LOS). By improving healthcare resources, anticipating and managing patients’ LOS may be essential to meeting the growing demand for healthcare. Hospitals may have resource shortages, and prolonged patient duration of stay results in decreased quality of care. More extended hospital stays are also associated with increased infection risks, depression, and reduced motivation, affecting a patient’s health after discharge and increasing the chance of readmission. Because postponing surgery boosts the patient’s risk of surgical site infections, preoperative LOS is fundamentally connected to a longer length of stay for the patient. Transferred patients frequently had a lower chance of being sent home than patients who had not been moved, while intra- and inter-hospital transfers may lengthen the length of stay (LOS). Therefore, extended hospital stays necessitate more frequent doctor visits, including late ward rounds, and heavy workloads can deteriorate medical professionals and reduce the effectiveness of clinical services.

References

Carpenter, A., Vora, S. M., Kestenbaum, S., Thompson, A., Devine, M., Tenison, E., Quicke, E., Ling, K., & Deibel, F. (2019). Afternoon ward rounds: Bad for patients, bad for doctors?Future Healthcare Journal, 6(2), 118-122. Web.

Delayed transfers of care: a quick guide. (2018). The King’s Fund. Web.

Gu, W., Fan, N., & Liao, H. (2021). Fitting aggregated phase-type distributions to the length-of-stay in intra-hospital patient transfers.Operations Research for Health Care, 29. Web.

Mueller, S., Zheng, J., Orav, E. J., & Schnipper, J. L. (2019). Inter-hospital transfer and patient outcomes: A retrospective cohort study.BMJ Quality & Safety, 28(11), 1-9. Web.

Mujagic, E., Marti, W. R., Coslovsky, M., Soysal, S. D., Mechera, R., von Strauss, M., Zeindler, J., Saxer, F., Mueller, A., Fux, C. A., Kindler, C., Gurke, L., & Weber, W. P. (2018). Associations of hospital length of stay with surgical site infections. World Journal of Surgery, 42, 3888–3896.

Murai, I. H., Fernandes, A. L., Sales, L. P., Pinto, A. J., Goessler, K. F., Duran, C. S., Silva, C. B., Franco, A. S., Macedo, M. B., Dalmolin, H. H., Baggio, J., Balbi, G. G., Reis, B. Z., Antonenangelo, L., Caparno, V. F., Gualano, B., & Pereira, R. M. (2021). Effect of a single high dose of vitamin D3 on hospital length of stay in patients with moderate to severe COVID-19: A randomized clinical trial. Jama, 325(11), 1053-1060.

Rahman, M. M., Kundu, D., Suha, S. A., Siddiqi, U. R., & Dey, S. K. (2022). Hospital patients’ length of stay prediction: A federated learning approach.Journal of King Saud University-Computer and Information Sciences. Web.

Wang, Z., Ji, J. S., Liu, Y., Liu, R., Zha, Y., Chang, X., Zhang, L., Liu, Q, Zhang, Y., Zeng, J., Dong, T., Xu, X. Zhou, L., He, J., Deng, Y., Zhong, B., & Wu, X. (2020). Survival analysis of hospital length of stay of novel coronavirus (COVID-19) pneumonia patients in Sichuan, China. Medrxiv.

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