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 Table of Contents  
EDITORIAL
Year : 2019  |  Volume : 3  |  Issue : 2  |  Page : 73-74

Average length of patient stay in inpatient and the emergency room


1 Royal College of Surgeons, Busaiteen, Bahrain
2 Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; University of Sharjah, Sharjah, United Arab Emirates

Date of Submission19-Jul-2019
Date of Decision30-Aug-2019
Date of Acceptance10-Sep-2019
Date of Web Publication23-Sep-2019

Correspondence Address:
Abbas Al Mutair
Editor-In-Chief, SCCJ P.O. Box: 271880, Riyadh

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2543-1854.267617

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How to cite this article:
Chagla H, Al Mutair A. Average length of patient stay in inpatient and the emergency room. Saudi Crit Care J 2019;3:73-4

How to cite this URL:
Chagla H, Al Mutair A. Average length of patient stay in inpatient and the emergency room. Saudi Crit Care J [serial online] 2019 [cited 2019 Dec 8];3:73-4. Available from: http://www.sccj-sa.org/text.asp?2019/3/2/73/267617



The rising demand for healthcare services urges the implementation of the most effective practices by healthcare institutions,[1] and the average length of stay (ALOS) is the measure considered to evaluate hospital efficiency by researchers, doctors, and policymakers around the world.[2]

The number of days spent at a hospital significantly impacts both the patient and the hospital. Decreased time spent in the hospital can lower the possible risk of opportunistic infections for patients and is often linked to better quality of treatment.[3] In addition to this, reduced LOS results in decreased medical fees for patients. Quicker discharges contribute to lesser congestion in the hospital's emergency department (ED),[4] allowing more availability of hospital beds and resources for incoming patients and in turn boosting hospital revenue.[3]

Over the past decade, several researches have been conducted on the ALOS in different patient groups. These include studies analyzing LOS in patients undergoing coronary artery surgery,[5] patients having hip injuries,[6] intensive care unit patients,[7],[8] and patients having pulmonary disease.[3],[9]

The LOS has been observed to vary across different countries. The data for the average number of days patients admitted to hospitals each year from 2007 to 2017 are presented in [Figure 1]. These data were obtained from the Organization for Economic Cooperation and Development.
Figure 1: Measuring the average length of stay of patients admitted by all causes across five Organization for Economic Cooperation and Development countries for the past 10 years

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Interpreting the variations between LOS of patients across the different countries requires taking into account factors, such as the difference in patient management by hospitals across the countries as well as the difference in patient profiles of each population.[3]

In addition to assessing differences between countries, it is also beneficial to assess the trends in hospitalization across the years within the same country. A longitudinal cohort study targeting the US population has used the National Inpatient Sample to assess long stay hospitalizations occurring for 10 years from 2002 to 2012. Based on the data collected, even though prolonged hospitalizations accounted for only 2% of all admissions, it represented 14% of all hospital days accounting for more than 20 billion dollars per annum. Results show that over time, prolonged hospitalizations were due to younger individuals and specifically those belonging to minority groups living in urban settings.[10] It was also concluded that over the 10-year duration, inpatient mortality in the US had decreased from 14.5% to 11.6% (P < 0.001).[10]

Furthermore, a study performed in England analyzing data through the National Health Service (NHS) records from 1997 to 2014 confirmed that the LOS for primary knee replacement decreased from 16 (95% confidence interval [CI] 14.9–17.2) days during 1997 to just 5.4 (5.2–5.6) days in 2014. The decrease in LOS is considered to be most likely a result of the increased efficiency of the healthcare system.[11]

Many previously performed studies have suggested a strong association between age and increased length of patient stay.[12],[13] A recently performed study, however, has produced results which disregard age as a factor influencing LOS and contradict the previous studies.[14] This indicates the need for more studies focusing on the impact of age on length of patient stay.

Low socioeconomic status and belonging to a minority race have also been linked to longer LOS. However, there is a lack of research regarding the impact that these factors have on LOS, and to make stronger associations, further research is needed.[4]

When evaluating LOS, hospital management policies must also be kept into consideration as a study performed using the NHS in the UK found that LOS varies greater across different hospitals than with different doctors working for at the same organization.[15]

Moreover, a study by Riguzzi et al. found that teaching hospitals are subjected to 15% increased LOS at the ED as compared to nonteaching hospitals all year round (95% CI = 11%–20%). Median LOS at nonteaching hospitals is 140 (interquartile range [IQR] = 81–232) min while median LOS at teaching hospitals is 165 (IQR = 94–276) min. This study however cannot be generalized to all teaching hospitals as it defines teaching hospitals as those having more than 25% of their patients looked over by residents. The study also did not take into account the difference between teaching hospitals having emergency medicine (EM) residents and those having non-EM residents working in the ED.[16]

Another study by Esmaeili et al. concluded that patient stay in the emergency room (ER) exceeding 24 h could be attributed to delayed decision-making by doctors and patients with complicated presenting complaints and delayed transferal of patients from the ER to their assigned departments by staff. The results of this study however are not confirmed and are only subjected to inference as the study was a cross-sectional study overlooking just one ED.[17]



 
  References Top

1.
van Oostveen CJ, Gouma DJ, Bakker PJ, Ubbink DT. Quantifying the demand for hospital care services: A time and motion study. BMC Health Serv Res 2015;15:15.  Back to cited text no. 1
    
2.
Sarkies MN, Bowles KA, Skinner EH, Mitchell D, Haas R, Ho M, et al. Data collection methods in health services research: Hospital length of stay and discharge destination. Appl Clin Inform 2015;6:96-109.  Back to cited text no. 2
    
3.
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. PLoS One 2018;13:e0195901.  Back to cited text no. 3
    
4.
Kreindler SA, Cui Y, Metge CJ, Raynard M. Patient characteristics associated with longer emergency department stay: A rapid review. Emerg Med J 2016;33:194-9.  Back to cited text no. 4
    
5.
Galas FR, Almeida JP, Fukushima JT, Osawa EA, Nakamura RE, Silva CM, et al. Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients. J Cardiothorac Surg 2013;8:54.  Back to cited text no. 5
    
6.
Neuman MD, Rosenbaum PR, Ludwig JM, Zubizarreta JR, Silber JH. Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA 2014;311:2508-17.  Back to cited text no. 6
    
7.
Kapadohos T, Angelopoulos E, Vasileiadis I, Nanas S, Kotanidou A, Karabinis A, et al. Determinants of prolonged intensive care unit stay in patients after cardiac surgery: A prospective observational study. J Thorac Dis 2017;9:70-9.  Back to cited text no. 7
    
8.
Liu X, Dawod Y, Wonnaparhown A, Shafi A, Doo L, Yoo JW, et al. Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis. Palliat Support Care 2017;15:741-52.  Back to cited text no. 8
    
9.
Alshabanat A, Otterstatter MC, Sin DD, Road J, Rempel C, Burns J, et al. Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates. Int J Chron Obstruct Pulmon Dis 2017;12:961-71.  Back to cited text no. 9
    
10.
Doctoroff L, Hsu DJ, Mukamal KJ. Trends in prolonged hospitalizations in the United States from 2001 to 2012: A longitudinal cohort study. Am J Med 2017;130:483-e1.  Back to cited text no. 10
    
11.
Burn E, Edwards CJ, Murray DW, Silman A, Cooper C, Arden NK, et al. Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: Evidence from linked primary care and NHS hospital records from 1997 to 2014. BMJ Open 2018;8:e019146.  Back to cited text no. 11
    
12.
Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: A review. Ann Emerg Med 2010;56:261-9.  Back to cited text no. 12
    
13.
Beauchet O, Launay CP, Fantino B, Lerolle N, Maunoury F, Annweiler C. Screening for elderly patients admitted to the emergency department requiring specialized geriatric care. J Emerg Med 2013;45:739-45.  Back to cited text no. 13
    
14.
Launay CP, Kabeshova A, Lanoé A, Chabot J, Levinoff EJ, Beauchet O. Age effect on the prediction of risk of prolonged length hospital stay in older patients visiting the emergency department: Results from a large prospective geriatric cohort study. BMC geriatrics 2018;18:127.  Back to cited text no. 14
    
15.
Tsai PF, Chen PC, Chen YY, Song HY, Lin HM, Lin FM, et al. Length of hospital stay prediction at the admission stage for cardiology patients using artificial neural network. J Healthc Eng 2016;2016: 703546.  Back to cited text no. 15
    
16.
Riguzzi C, Hern HG, Vahidnia F, Herring A, Alter H. The July effect: Is emergency department length of stay greater at the beginning of the hospital academic year? Western J Emerg Med 2014;15:88.  Back to cited text no. 16
    
17.
Esmaeili R, Aghili SM, Sedaghat M, Afzalimoghaddam M. Causes of prolonged emergency department stay; a cross-sectional action research. Adv J Emerg Med 2018;2:e18.  Back to cited text no. 17
    


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