ReviewDeclining Length of Hospital Stay for Pneumonia and Postdischarge Outcomes
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.
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2017, InjuryCitation Excerpt :Moreover, there is evidence that patients are being discharged with active clinical problems [11,29]. However, studies from acute medical illness suggest that reduced length of stay does not necessarily increase the risk of readmission [46,47]. In our study, there also appeared to be no consistent effect of length of stay on readmission risk.
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2015, Clinical Microbiology and InfectionCitation Excerpt :For patients hospitalized with pneumonia, several studies have documented substantial decreases in LOS over the last decades [6–9]. In many studies, the reduction in LOS was not accompanied by higher mortality or more readmissions [6–8]. In others, more patients were discharged in an unstable condition, and subsequent mortality and readmission rates were increased in these patients [10,11].
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2014, Archives of Gerontology and GeriatricsCitation Excerpt :Mortality rates were not significantly different. Evolution in length of stay and short-term outcomes (in-hospital and 30-day mortality, 30-days readmission) have been already debated in the literature (Bueno et al., 2010; Capelastegui et al., 2008; Sin Dan & Tu Jack, 2000), which suggested that premature discharge could be deleterious for vulnerable patients with complex medico-social situation. A worst medical status itself could also play a role.
Can we use severity assessment tools to increase outpatient management of community-acquired pneumonia?
2012, European Journal of Internal Medicine
Sources of support: none.