Z. G. Hashmi1, K. Florecki1, B. Covey1, D. Codling1, K. Sweeney1, L. Smith1, T. McNay1, H. Park1 1Sinai Hospital Of Baltimore,Department Of Surgery,Baltimore, MD, USA
Introduction:
Prior research cites non-clinical reasons, such as delays in rehabilitation facility placements, as the predominant cause for prolonged length of stay (LOS) in trauma. However, the currently used total LOS metric is non-informative to specifically measure delays due to these non-clinical reasons. The objective of this study is to evaluate post-anticipated discharge length of stay (PAD-LOS) as a more actionable QI and benchmarking metric in trauma. We hypothesize that the PAD-LOS will provide a better target to improve efficiency in transitions to post-acute care.
Methods:
All adult (≥16 years) trauma patients with blunt/penetrating injuries discharged by the Trauma Service at a Level II Trauma Center between October 2015 and May 2016 were included. Post-anticipated discharge length of stay (PAD-LOS) was defined as the LOS after the attending surgeon’s decision to discharge the patient, marking the completion of active clinical care. Patient demographic and injury characteristics were identified using the institutional trauma registry. Inpatient cost estimates were calculated using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) 2013.
Results:
A total of 185 trauma patients were identified. Most of the patients were young (median age 45, interquartile range 28-65 years), males (62%) with blunt injuries (77%). More than one third of the patients (69/185) had non-home discharge dispositions, while 22% were uninsured. Complete PAD-LOS data was recorded for 84 patients. Overall, PAD-LOS accounted for 28.5% (104/364 patient days) of in-patient time with an estimated attributable cost of $213,164. Non-home discharges had higher PAD-LOS, with discharges to inpatient rehabilitation requiring an additional 2 days of non-clinical hospital stay (Figure 1).
Conclusion:
Post-anticipated discharge length of stay readily identifies groups at high risk for prolonged LOS and provides an actionable target to directly address delays in discharge due to non-clinical reasons. At individual trauma centers, PAD-LOS can help drive quality improvement (QI) initiatives to improve discharge efficiency. System-wide, PAD-LOS benchmarking may enable separate, more informed quality of care comparisons between trauma centers by differentiating prolonged LOS attributable to clinical and non-clinical reasons and help implement targeted QI initiatives.
