Review
Declining Length of Hospital Stay for Pneumonia and Postdischarge Outcomes

https://doi.org/10.1016/j.amjmed.2008.05.010Get rights and content

Abstract

Objective

This study was designed to assess 8-year trends in the duration of hospitalization for community-acquired pneumonia and to evaluate the impact of declining length of stay on postdischarge short-term readmission and mortality.

Methods

We conducted a prospective observational cohort study of 1886 patients with community-acquired pneumonia who were discharged from a single hospital between March 1, 2000, and June 30, 2007. The main outcomes measured were all-cause mortality and hospital readmission during the 30-day period after discharge. Regression models were used to identify risk factors associated with hospital length of stay and the adjusted associations between length of stay and mortality and readmission.

Results

Factors associated with a longer hospital stay included the number of comorbid conditions, high risk classification on the Pneumonia Severity Index, bilateral or multilobe radiographic involvement, and treatment failure. Patients treated with an appropriate antibiotic were less likely to have an increased length of stay. The mean length of stay was significantly shorter during the 2006 to 2007 period (3.6 days) than during the 2000 to 2001 period (5.6 days, P <.001). Despite the reduction in length of stay, there were no significant differences in the likelihood of death or readmission at 30 days between the 2 time periods. Adjusted multivariate analysis showed that patients with hospital stays less than 3 days did not have significant increases in postdischarge outcomes.

Conclusion

The marked decreased in the length of stay for patients hospitalized with community-acquired pneumonia since 2000 has not been accompanied by an increase in short-term mortality or hospital readmission.

Section snippets

Design and Setting

This prospective, observational study was carried out in Galdakao Hospital, a 400-bed teaching hospital in the Basque Country (northern Spain) that serves a population of 300,000 inhabitants. Galdakao Hospital belongs to the network of public hospitals of the Basque Health Care Service, which provides free unrestricted care to approximately 100% of the population. The project was approved by the hospital's ethics review board.

Study Population

Adults aged 18 years or more who were admitted to the hospital's

Results

The characteristics of the cohort by quartile of hospital length of stay are shown in Table 1. Patients in the lowest length-of-stay quartile had the fewest comorbidities and less severe community-acquired pneumonia on admission, were prescribed more appropriate antibiotics, and experienced less treatment failure.

Stability criteria on discharge were recorded beginning in July of 2003. Among the 1183 patients discharged alive with recorded stability criteria, 315 (29.1%) were discharged before

Discussion

In this observational study, a significant 2-day decline in hospital length of stay for community-acquired pneumonia between the period 2000 to 2001 and the period 2006 to 2007 was not associated with an increase in short-term postdischarge mortality and readmission, even after adjusting for potential prognostic confounders.

These observations support recent findings by Fishbane et al21 that the use of clinical guidelines led to a substantial reduction in length of stay while maintaining and

Conclusions

The results of this population-based study reveal a marked decreased in length of hospital stay for patients with community-acquired pneumonia from 2000 to 2007. This trend was not associated with any erosion in rates of short-term mortality and hospital readmission. This trend offers potential cost-savings for health insurance companies and hospitals, as well as psychologic benefits for patients. It is apparent, however, that an increasingly greater proportion of patients who have had a

Acknowledgments

We thank the staff members of the different services for their support. We also thank Patrick J. Skerrett for assistance editing the article.

References (29)

  • D.W. Baker et al.

    Mortality trends during a program that publicly reported hospital performance

    Med Care

    (2002)
  • D.W. Baker et al.

    Trends in post-discharge mortality and readmissions: has length of stay declined too far ?

    Arch Intern Med.

    (2004)
  • J.A. Ramirez et al.

    Early switch from intravenous to oral antibiotics and early hospital discharge

    Arch Intern Med.

    (1999)
  • R.V. Nathan et al.

    In-hospital observation after antibiotic switch in pneumonia: a national evaluation

    Am J Med.

    (2006)
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