Background
Methods
Study design
Study population
Setting
Data
Outcome
Exposures
Characteristics | Hospital A (n = 1940)a
| Hospital P (n = 949)a
| Overall (n = 2889)a
|
p valueb
| ||
---|---|---|---|---|---|---|
LOS | LOS (days) | Mean, SD | 1.8 ± 2.4 | 1.7 ± 2.8 | 1.8 ± 2.6 | 0.654 |
LOS ≥ 1.8 days | 39.7 | 36.5 | 38.7 | 0.089 | ||
LOS < 24 h | 20 | 23.5 | 21.1 | 0.288 | ||
Demographic | Gender | Male | 56.3 | 55.1 | 55.9 | 0.532 |
Age (years) | Mean, SD | 3.9 ± 4.4 | 3.8 ± 4.2 | 3.7 ± 4.2 | 0.937 | |
Age group (years) | 1 and Under | 40 | 40.9 | 40.3 | 0.509 | |
2 to 5 | 34.1 | 34.7 | 34.3 | |||
6 to 10 | 12.9 | 13.4 | 13.1 | |||
11 to 16 | 13 | 11.1 | 12.4 | |||
Ethnic Group | White | 28.9 | 39.2 | 32.3 | <0.001 | |
Mixed White | 23.2 | 24 | 23.5 | |||
Asian | 33.6 | 23.9 | 30.4 | |||
Black | 8.4 | 5.2 | 7.3 | |||
Other or not specified | 5.9 | 5.9 | 6.5 | |||
Distance (Km)a
| Mean | 6.3 ± 14.7 | 4.8 ± 14.7 | 6.3 ± 23.2 | ||
Distance (quartiles) a
| 1st (live closest) | 20 | 35 | 24.9 | <0.001 | |
2nd | 25 | 25.2 | 25.1 | |||
3rd | 25.7 | 23.5 | 25 | |||
4th (live furthest) | 29.2 | 16.3 | 25 | |||
IDACI | Mean | 0.3 ± 0.14 | 0.43 ± 0.17 | 0.34 ± 0.17 | ||
IDACI (quartiles)c
| 1st (least deprived) | 30.8 | 12.9 | 24.9 | <0.001 | |
2nd | 28.8 | 17.3 | 25 | |||
3rd | 25.9 | 23 | 24.9 | |||
4th (most deprived) | 14.6 | 46.8 | 25.1 | |||
Clinical | Specialty | Medical | 82.8 | 93.5 | 86.3 | <0.001 |
Surgical | 17.2 | 6.5 | 13.7 | |||
Diagnosis | allergy | 0.4 | 0.6 | 0.5 | <0.001 | |
cardiac | 1 | 0.7 | 0.9 | |||
endocrine | 1.1 | 2.1 | 1.5 | |||
gastro | 13.6 | 10.6 | 12.6 | |||
haemoncology | 5.4 | 4.7 | 5.2 | |||
infection | 21.6 | 21.6 | 21.6 | |||
MSK | 1.5 | 1.7 | 1.6 | |||
neurology | 6.1 | 9.3 | 7.1 | |||
other | 2.4 | 1.9 | 2.3 | |||
psychosocial | 1.3 | 1.8 | 1.5 | |||
respiratory | 20 | 24.7 | 21.5 | |||
surgical GIT | 1.8 | 1 | 1.5 | |||
trauma | 12.7 | 12.1 | 13.2 | |||
urogenital | 4.9 | 3.6 | 1.8 | |||
Maxfax/Dental/ ENT | 3.9 | 1.4 | 3.1 | |||
congenital | 0.4 | 0 | 0.3 | |||
Dermatology | 2 | 2.2 | 2.1 | |||
Number of admissions (in the year) | 1 | 64.5 | 71 | 66.6 | 0.005 | |
2 | 18.8 | 15.9 | 17.8 | |||
3 | 6.4 | 5.5 | 6.1 | |||
4 or more | 10.4 | 7.6 | 9.5 | |||
Readmission within 28 days | 2.5 | 3.4 | 2.8 | 0.196 | ||
Process | Time of admission | 9.00 to 16.59 | 33.8 | 36.4 | 34.6 | 0.105 |
17.00 to 21.59 | 27.5 | 28.9 | 28 | |||
22.00 to 08.59 | 38.7 | 34.7 | 37.4 | |||
Day of admission | weekday | 85.7 | 88 | 86.5 | 0.095 | |
weekend | 14.3 | 12 | 13.5 | |||
Season of admission | spring | 26.8 | 28.1 | 27.2 | 0.58 | |
summer | 23.8 | 23.8 | 23.8 | |||
autumn | 25 | 25.8 | 25.2 | |||
winter | 24.5 | 22.2 | 23.8 | |||
Source of admission | elective | 9.6 | 3.6 | 7.7 | <0.001 | |
emergency via A&E | 74.6 | 88.6 | 79.2 | |||
emergency via other | 13 | 6.9 | 11 | |||
other | 27 | 1 | 2.1 |
Statistical methods
Results
Characteristic | prolonged length of stay | Overall (n = 2889)a
|
p valueb
| |||
---|---|---|---|---|---|---|
Less than 1.8 days (n = 1772) a
| Greater than or equal to 1.8 days (n = 1117)a
| |||||
Hospital site | P (Paediatric led A&E) | 34 | 31 | 61.3 | 0.089 | |
A (Adult physician led A&E) | 66 | 69 | ||||
Demographic | Gender | Male | 56.4 | 55.2 | 55.9 | 0.584 |
Female | 43.6 | 44.8 | ||||
Age (years) | mean, SD | 4.2 ± 4.4 | 3.4 ± 4.4 | 3.9 ± 4.4 | <0.001 | |
Age group (years) | 1 and Under | 35.4 | 48 | 40.3 | <0.001 | |
2 to 5 | 36.9 | 30.1 | 34.3 | |||
6 to 10 | 14.2 | 11.3 | 13.1 | |||
11 to 16 | 13.5 | 10.7 | 12.4 | |||
Ethnic Group | White | 32.3 | 32.2 | 32.3 | 0.706 | |
Mixed White | 23.3 | 23.8 | 23.5 | |||
Asian | 30.5 | 3.3 | 30.4 | |||
Black | 7 | 7.9 | 7.3 | |||
Other/unspecified | 6.9 | 5.8 | 6.5 | |||
Distance (Km)a
| Mean | 6.5 ± 24.8 | 6.1 ± 20.3 | 6.3 ± 23.2 | 0.107 | |
Distance (quartiles)a
| 1st (closest) | 23.5 | 27.2 | 24.9 | 0.135 | |
2nd | 25.8 | 24 | 25.1 | |||
3rd | 25 | 25.1 | 25 | |||
4th (furthest) | 25.8 | 23.8 | 25 | |||
IDACI | Mean | 0.3 ± 0.14 | 0.43 ± 0.17 | 0.34 ± 0.17 | 0.685 | |
Median | 0.31 | 0.32 | 0.32 | |||
IDACI (quartiles)c
| 1st (least deprived) | 25.3 | 24.3 | 24.9 | <0.001 | |
2nd | 25.1 | 24.8 | 25 | |||
3rd | 23.3 | 27.6 | 24.9 | |||
4th (most deprived) | 26.3 | 23.3 | 25.1 | |||
Clinical | Specialty | Medical | 82.1 | 93 | 86.3 | <0.001 |
Surgical | 18 | 6.9 | 13.7 | |||
Diagnosis | allergy | 0.5 | 0.5 | 0.5 | <0.001 | |
cardiac | 0.8 | 1.1 | 1.5 | |||
endocrine | 1.2 | 1.9 | 2.6 | |||
gastro | 12.7 | 12.5 | 12.6 | |||
haemoncology | 4.8 | 5.7 | 5.2 | |||
infection | 20.2 | 23.8 | 21.6 | |||
MSK | 1.8 | 1.2 | 1.6 | |||
neurology | 7.6 | 6.5 | 7.1 | |||
other | 2.3 | 2.2 | 2.3 | |||
psychosocial | 1.9 | 9 | 1.5 | |||
respiratory | 19.6 | 24.5 | 21.5 | |||
surgical GIT | 6.2 | 2.9 | 1.5 | |||
trauma | 16.5 | 6.2 | 12.5 | |||
urogenital | 3.8 | 5.4 | 4.4 | |||
Maxfax/Dental/ENT | 3.9 | 1.8 | 3.1 | |||
congenital | 0.3 | 0.3 | 0.3 | |||
Dermatology | 1.7 | 2.7 | 2.1 | |||
Number of admissions in the year | 1 | 68.2 | 64.2 | 66.6 | 0.038 | |
2 | 17.7 | 18.1 | 17.8 | |||
3 | 5.3 | 7.4 | 6.1 | |||
4 or more | 8.9 | 10.3 | 9.5 | |||
Readmission within 28 days | 2.8 | 2.8 | 2.8 | 0.941 | ||
Process | Time of admission | 9.00 to 16.59 | 33.5 | 36.4 | 34.6 | <0.001 |
17.00 to 21.59 | 24 | 34.4 | 28 | |||
22.00 to 08.59 | 42.6 | 29.2 | 37.4 | |||
Day of admission | weekday | 85.9 | 87.4 | 86.5 | 0.256 | |
weekend | 14.1 | 12.6 | 13.5 | |||
Season of admission | spring | 26.4 | 28.6 | 27.2 | 0.58 | |
summer | 24.6 | 22.6 | 23.8 | |||
autumn | 24.7 | 26.1 | 25.2 | |||
winter | 24.4 | 22.7 | 23.8 | |||
Source of admission | elective | 11 | 2.4 | 7.7 | <0.001 | |
emergency via A&E | 75.6 | 85.1 | 79.2 | |||
emergency via other | 12.3 | 9 | 11 | |||
other | 11.9 | 3.6 | 2.1 |
Model 1 | Model 2 | Model 3 | Model 4 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
LOS | IDACI (quartiles) | OR | 95% CI |
p value | OR | 95% CI |
p value | OR | 95% CI |
p value | OR | 95% CI |
p value |
≥ to 1.8 days (mean) | 1st (least) | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - |
2nd | 1.04 | 0.84, 1.29 | 0.696 | 1.07 | 0.86, 1.34 | 0.54 | 1.07 | 0.85, 1.35 | 0.538 | 1.03 | 0.81, 1.30 | 0.824 | |
3rd | 1.26 | 1.02, 1.56 | 0.035 | 1.29 | 1.04, 1.61 | 0.023 | 1.27 | 1.01, 1.59 | 0.041 | 1.24 | 0.98, 1.57 | 0.068 | |
4th (most) | 0.98 | 0.78, 1.24 | 0.757 | 0.97 | 0.77, 1.23 | 0.795 | 1.00 | 0.78, 1.27 | 0.992 | 0.96 | 0.75, 1.23 | 0.746 | |
≥to 4 days | 1st (least) | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - |
2nd | 1.13 | 0.88, 1.49 | 0.325 | 1.16 | 0.88, 1.52 | 0.285 | 1.18 | 0.89, 1.56 | 0.246 | 1.17 | 0.88, 1.57 | 0.288 | |
3rd | 1.27 | 0.97, 1.64 | 0.069 | 1.28 | 0.98, 1.68 | 0.072 | 1.23 | 0.93, 1.62 | 0.151 | 1.20 | 0.91, 1.59 | 0.196 | |
4th (most) | 0.96 | 0.70, 1.25 | 0.767 | 0.93 | 0.69, 1.25 | 0.638 | 0.96 | 0.71, 1.30 | 0.813 | 0.96 | 0.71, 1.30 | 0.789 | |
>24 h (median) | 1st (least) | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - |
2nd | 1.21 | 0.94, 1.56 | 0.1516 | 1.19 | 0.92, 1.55 | 0.189 | 1.17 | 0.90, 1.54 | 0.237 | 1.05 | 0.79, 1.41 | 0.730 | |
3rd | 1.17 | 0.91, 1.51 | 0.221 | 1.17 | 0.90, 1.52 | 0.233 | 1.14 | 0.87, 1.49 | 0.359 | 1.11 | 0.83, 1.49 | 0.476 | |
4th (most) | 1.18 | 0.90, 1.54 | 0.230 | 1.14 | 0.87, 1.50 | 0.33 | 1.18 | 0.89, 1.57 | 0.249 | 1.07 | 0.79, 1.45 | 0.670 | |
IRR | 95% CI |
p value | IRR | 95% CI |
p value | IRR | 95% CI |
p value | IRR | 95% CI |
p value | ||
Days | 1st (least) | ref | - | - | ref | - | - | ref | - | - | ref | - | - |
2nd | 1.07 | 0.95, 1.19 | 0.298 | 1.06 | 0.95, 1.19 | 0.310 | 1.06 | 0.94, 1.18 | 0.351 | 1.05 | 0.93, 1.17 | 0.443 | |
3rd | 1.16 | 1.04, 1.30 | 0.009 | 1.17 | 1.04, 1.31 | 0.009 | 1.14 | 1.02, 1.28 | 0.022 | 1.13 | 1.01, 1.27 | 0.027 | |
4th (most) | 1.14 | 1.01, 1.29 | 0.031 | 1.12 | 0.99, 1.27 | 0.061 | 1.13 | 1.01, 1.28 | 0.040 | 1.12 | 1.00, 1.26 | 0.056 |
Model 1 | Model 2 | Model 3 | Model 4 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
LOS | Hospital | OR | 95% CI |
p value | OR | 95% CI |
p value | OR | 95% CI |
p value | OR | 95% CI |
p value |
≥1.8 days (mean) | P | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - |
A | 1.15 | 0.97, 1.37 | 0.104 | 1.22 | 1.02, 1.46 | 0.030 | 1.31 | 1.09, 1.58 | 0.004 | 1.41 | 1.16, 1.70 | <0.001 | |
≥4 days | P | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - |
A | 1.06 | 0.85, 1.31 | 0.614 | 1.09 | 0.87, 1.35 | 0.456 | 1.12 | 0.89, 1.41 | 0.323 | 1.14 | 0.91, 1.44 | 0.262 | |
>24 h (median) | P | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - | 1.00 | - | - |
A | 1.28 | 1.05, 1.57 | 0.015 | 1.38 | 1.12, 1.69 | 0.002 | 1.65 | 1.32, 2.05 | <0.001 | 1.95 | 1.53, 2.48 | <0.001 | |
IRR | 95% CI |
p value | IRR | 95% CI |
p value | IRR | 95% CI |
p value | IRR | 95% CI |
p value | ||
Days | P | ref | - | - | ref | - | - | ref | - | - | ref | - | - |
A | 1.06 | 0.97, 1.16 | 0.194 | 1.09 | 0.99, 1.19 | 0.075 | 1.14 | 1.04, 1.26 | 0.005 | 1.13 | 1.04, 1.23 | 0.003 |