System-Related Issues at the Core of Prolonged Hospital Stay

Excessively prolonged hospitalization (ExProH) in trauma patients is not related to the severity of illness, according to a new study.

Researchers at Massachusetts General Hospital (MGH; Boston, USA) and Harvard Medical School (Boston, MA, USA) conducted a study to identify the causes of ExProH in trauma patients. To do so, the researchers reviewed trauma registry, billing databases, and medical records of 3,237 trauma patient admissions between January 1, 2006, and December 31, 2010. ExProH was defined by a hospital stay that exceeds the diagnosis-related group-based trim point set by insurers. The main outcome measures were ExProH and hospital cost.

The results showed that 5% of the patients had ExProH. They were older, were more likely to have blunt trauma, were more likely to be self-payers covered by Medicare/Medicaid, were more likely to be discharged to post-acute care facilities than home, and had higher hospitalization cost (USD 54,646 compared to USD 18,444, respectively). Both groups had similar injury severity scores, revised trauma scores, baseline comorbidities, and in-hospital complication rates. Independent predictors of mortality were discharge to a rehabilitation facility or other post-acute care facility, as well as insurance type. The study was published in the August 21, 2013, issue of JAMA Surgery.

“The reasons for discharge delays were clinical in only 20% of the cases; the remaining discharges were excessively delayed because of difficulties in rehabilitation facility placement, in-hospital operational delays, or payer-related issues,” concluded lead author John Hwabejire, MD, and colleagues of the division of trauma and emergency surgery. “System-related issues, not severity of illness, prolong hospital stay excessively. Cost-reduction efforts should target operational bottlenecks between acute and post-acute care.”

Related Links:
Massachusetts General Hospital
Harvard Medical School