Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T21:08:53.829Z Has data issue: false hasContentIssue false

Use of Acute Care Hospitals by Long-Stay Patients: Who, How Much, and Why?

Published online by Cambridge University Press:  31 March 2010

Carolyn De Coster*
Affiliation:
Department of Community Health Sciences, University of Manitoba
Sharon Bruce
Affiliation:
Department of Community Health Sciences, University of Manitoba
Anita Kozyrskyi
Affiliation:
Department of Community Health Sciences, University of Manitoba
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être addressées à : Carolyn De Coster, Ph.D., R.N., Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 727 McDermot Avenue, Suite 408, Winnipeg, MB R3E 3P5. ([email protected])

Abstract

The effects of long-term hospitalizations can be severe, especially among older adults. In Manitoba, between fiscal years 1991/1992 and 1999/2000, 40 per cent of acute care hospital days were used by the 5 per cent of patients who had long stays, defined as stays of more than 30 days. These proportions were remarkably stable, despite major changes in the bed supply. Approximately two thirds of long-stay patients were aged 75 or older. Medical record review for a small sample of long-stay medical patients aged 75 or older revealed that 42 per cent of the days spent in hospital were spent either awaiting transfer to another level of care (home care, nursing home, or chronic care), or were due to in-hospital factors, such as awaiting consults, tests, or treatments. Hospital information systems and early discharge planning may help to alleviate lengthy discharge delays and result in better care for these patients.

Résumé

Résumé; Les conséquences des hospitalisations à long terme peuvent être graves, particulièrement chez les personnes âgées. Au Manitoba, entre les exercices 1991/1992 et 1999/2000, 40 p. 100 des journées d'hospitalisation de courte durée ont été utilisées par 5 p. 100 des patients qui avaient eu des hospitalisations prolongées, c'est-à-dire des séjours de plus de 30 jours. Ces proportions étaient remarquablement stables, malgré des changements importants quant au nombre de lits disponibles. Environ les deux tiers des patients de longue durée étaient âgés de 75 ans ou plus. L'étude des dossiers médicaux d'un petit échantillon des patients de longue durée, âgés de 75 ans ou plus, a révélé que 42 p. 100 des journées passées à l'hôpital avaient été passées soit à attendre un transfert vers un autre niveau de soins (soins à domicile, maison de soins infirmiers ou soins aux malades chroniques) soit à attendre en raison de facteurs propres à l'hô pital, notamment l'attente pour des consultations, des examens ou des traitements. Les systèmes d'information des hôpitaux ainsi que la planification des congés précoces des hôpitaux permettraient éventuellement d'alléger les longues attentes de congés et d'offrir de meilleurs soins à ces patients.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Advisory Committee on Clinical Resource Management. (1997). Acute medical beds: How are they used in British Columbia? Victoria, BC: Ministry of Health and Ministry Responsible for Seniors.Google Scholar
Anders, R.L. (1993). Administrative delays: Is there a difference between for-profit and non-profit hospitals? Journal of Nursing Administration, 23(11), 4250.CrossRefGoogle Scholar
Barrett, B.J., McDonald, J.R., & Parfrey, P.S. (1994). Extended stay in acute care hospitals: A study to identify determinants and potential interventions. Annals (Royal College of Physicians and Surgeons of Canada), 27(3), 140144.Google Scholar
Black, C.D., Roos, N.P., & Burchill, C.A. (1993). Utilization of hospital resources: Vol. 2. Methods and tables. Winnipeg: Manitoba Centre for Health Policy and Evaluation.Google Scholar
Brennan, T.A., Leape, L.L., Laird, N.M., Hebert, L., Localio, A.R., Lawthers, A.G., Newhouse, J.P., Weiler, P.C., & Hiatt, H.H. (1991). Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I. New England Journal of Medicine, 324(6), 370376.CrossRefGoogle ScholarPubMed
Bruce, S., De Coster, C., Trumble Waddell, J., Burchill, C.A., & De Haney, S. (2001). Acuity of patients hospitalized for medical conditions at Winnipeg acute care hospitals. Winnipeg: Manitoba Centre for Health Policy and Evaluation.Google Scholar
Campion, E.W., Bang, A., & May, M.I. (1983). Why acute care hospitals must undertake long-term care. New England Journal of Medicine, 308(2), 7175.CrossRefGoogle ScholarPubMed
De Coster, C., & Kozyrskyj, A. (2000). Long-stay patients in Winnipeg acute care hospitals. Winnipeg: Manitoba Centre for Health Policy and Evaluation.Google Scholar
De Coster, C., Peterson, S., Carrière, K.C., & Kasian, P. (1999). Assessing the extent to which hospitals are used for acute care purposes. Medical Care, 37(Suppl. 6), JS151JS166.Google ScholarPubMed
De Coster, C., Peterson, S., & Kasian, P. (1996). Alternatives to acute care. Winnipeg: Manitoba Centre for Health Policy and Evaluation.Google Scholar
De Coster, C., Roos, N.P., Carrière, K.C., & Peterson, S. (1997). Inappropriate hospital use by patients receiving care for medical conditions: Targeting utilization review. Canadian Medical Association Journal, 157(7), 889896.Google ScholarPubMed
De la Sierra, A., Cardellach, F., Cobo, E., Bove, A., Roige, M., Santos, M.J., Ingelmo, M., & Urbano-Marquez, A. (1989). Iatrogenic illness in a department of general internal medicine: A prospective study. Mount Sinai Journal of Medicine, 56(4), 267271.Google Scholar
Fine, M.J., Pratt, H.M., Obrosky, D.S., Lave, J.R., McIntosh, L.J., Singer, D.E., Coley, C.M., & Kapoor, W.N. (2000). Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. American Journal of Medicine, 109(5), 378385.CrossRefGoogle ScholarPubMed
Giraud, T., Dhainaut, J.F., Vaxelaire, J.F., Joseph, T., Journois, D., Bleichner, G., Sollet, J.P., Chevret, S., & Monsallier, J.F. (1993). Iatrogenic complications in adult intensive care units: A prospective two-center study. Critical Care Medicine, 21(1), 4051.CrossRefGoogle ScholarPubMed
Health Services Utilization and Research Commission. (1994). Barriers to community care. Saskatoon: Author.Google Scholar
Hochstein, A. (1985). Treating long-stay patients in acute hospital beds: An economic diagnosis. Gerontologist, 25(2), 161165.CrossRefGoogle ScholarPubMed
Inglis, A.L., Coast, J., Gray, S.F., Peters, T.J., & Frankel, S. (1995). Appropriateness of hospital utilization. Medical Care, 9, 952957.CrossRefGoogle Scholar
InterQual. (1999). ISD-AC Intensity of Service Severity of Illness Discharge Services. Marlborough, MA: InterQual, Division of Access Health, Inc.Google Scholar
InterQual. (1999). ISD-SAC Intensity of Service Severity of Illness Discharge Services. Marlborough, MA: InterQual, Division of Access Health, Inc.Google Scholar
Jacobs, P., Shanahan, M., Roos, N.P., & Farnworth, M.G. (1999). Cost list for Manitoba Health Services. Winnipeg: Manitoba Centre for Health Policy and Evaluation.Google Scholar
Joint Policy and Planning Committee. (1997). Non-acute hospitalization report (adult). Toronto: Author.Google Scholar
Kohli, H.S., Bhaskaran, M.C., Muthukumar, T., Thennarasu, K., Sud, K., Jha, V., Gupta, K.L., & Sakhuja, V. (2000). Treatment-related acute renal failure in the elderly: A hospital-based prospective study. Nephrology, Dialysis, Transplantation, 15(2), 212217.CrossRefGoogle ScholarPubMed
Kozyrskyj, A., Black, C., Chateau, D., & Steinbach, C. (2005). Discharge outcomes in seniors hospitalized for more than 30 days. Canadian Journal of Aging, 24(Suppl. 1), 107119.CrossRefGoogle Scholar
Leape, L.L., Brennan, T.A., Laird, N., Lawthers, A.G., Localio, A.R., Barnes, B.A., Hebert, L., Newhouse, J.P., Weiler, P.C., & Hiatt, H. (1991). The nature of adverse events in hospitalized patients: Results of the Harvard Medical Practice Study II. New England Journal of Medicine, 324(6), 377384.CrossRefGoogle ScholarPubMed
Lefevre, F., Feinglass, J., Potts, S., Soglin, L., Yarnold, P., Martin, G.J., & Webster, J.R. (1992). Iatrogenic complications in high-risk, elderly patients. Archives of Internal Medicine, 152(10), 20742080.CrossRefGoogle ScholarPubMed
Lyketsos, C.G., Sheppard, J.M., & Rabins, P.V. (2000). Dementia in elderly persons in a general hospital. American Journal of Psychiatry, 157(5), 704707.CrossRefGoogle ScholarPubMed
Mayo, N.E., Wood-Dauphinee, S., Gayton, D., & Scott, S.C. (1997). Nonmedical bed-days for stroke patients admitted to acute care hospitals in Montreal, Canada. Stroke, 28(3), 543549.CrossRefGoogle ScholarPubMed
McFarland, L.V. (1995). Epidemiology of infectious and iatrogenic nosocomial diarrhea in a cohort of general medicine patients. American Journal of Infection Control, 23(5), 295305.CrossRefGoogle Scholar
Menec, V.H., MacWilliam, L., Soodeen, R., & Mitchell, L. (2002). The health and health care use of Manitoba's seniors: Have they changed over time? Winnipeg: Manitoba Centre for Health Policy.Google Scholar
Palmer, R.M. (1995). Acute hospital care of the elderly: Minimizing the risk of functional decline. Cleveland Clinic Journal of Medicine, 62(2), 117128.CrossRefGoogle ScholarPubMed
Rissanen, P., Aro, S., & Paavolainen, P. (1996). Hospital- and patient-related characteristics determining length of hospital stay for hip and knee replacements. International Journal of Technology Assessment in Health Care, 12(2), 325335.CrossRefGoogle ScholarPubMed
Roos, L.L., Mustard, C.A., Nicol, J.P., McLerran, D.F., Malenka, D.K., Young, K.T., & Cohen, M.M. (1993). Registries and administrative data: Organization and accuracy. Medical Care, 31(3), 201212.CrossRefGoogle ScholarPubMed
Roos, L.L., Sharp, S.M., & Cohen, M.M. (1991). Comparing clinical information with claims data: Some similarities and differences. Journal of Clinical Epidemiology, 44(9), 881888.CrossRefGoogle ScholarPubMed
Stern, S.H., Singer, L.B., & Weissman, S.E. (1995). Analysis of hospital cost in total knee arthroplasty: Does length of stay matter? Clinical Orthopedics, 321, 3644.Google Scholar
Strumwasser, I., Paranjpe, N.V., Ronis, D.L., Share, D., & Sell, L.J. (1990). Reliability and validity of utilization review criteria. Medical Care, 28, 95109.CrossRefGoogle ScholarPubMed
Tepp, J., & Voitk, A. (1999). Hip fracture as a complication of hospitalization. International Journal of Health Care Quality Insurance Incorporating Leadership in Health Services, 12(6–7), xxiii.Google ScholarPubMed
Thomas, E.J., & Brennan, T.A. (2000). Incidence and types of preventable adverse events in elderly patients: Population based review of medical records. British Medical Journal, 320(7237), 741744.CrossRefGoogle ScholarPubMed
Tracey, F., Taylor, I.C., & McConnell, J.G. (1998). A prospective study of the process of assessment and care management in the discharge of elderly patients from hospital. Ulster Medical Journal, 67(1), 3640.Google ScholarPubMed
Trerise, B., Dodek, P., Leung, A., & Spinelli, J.J. (1999). Inappropriate underutilization of services in an acute care hospital. Vancouver: Centre for Health Evaluation and Outcome Sciences.Google Scholar
Williams, J.I., & Young, W. (1997). Inventory of studies on the accuracy of Canadian health administrative databases. Toronto: Institute for Clinical Evaluative Sciences.Google Scholar
Winnipeg Regional Health Authority. (2001). Strategic directions for the Personal Care Home Program. Winnipeg: Author.Google Scholar
Wright, C.J., & Cardiff, K. (1998). The utilization of acute care medical beds in Prince Edward Island. Vancouver: Centre for Health Services and Policy Research.Google Scholar
Yuen, E.J., Zisselman, M.H., Louis, D.Z., & Rovner, B.W. (1997). Sedative-hypnotic use by the elderly: Effects on hospital length of stay and costs. Journal of Mental Health Administration, 24(1), 9097.CrossRefGoogle ScholarPubMed