Abishek Tumma is a medical registrar currently training at the Princess Alexandra Hospital.
Factors Affecting Prolonged Hospital Admissions In Regional Australia
Abishek Tumma, Toowoomba Base Hospital, Toowoomba, Australia
Lasanthi Paranavithana, Toowoomba Base Hospital, Toowoomba, Australia
Aims: Hospitals are under constant pressure to improve bed turnover and reduce length of stay (LOS). International evidence describes multiple factors associated with prolonged LOS in various patient populations. However, there is limited evidence to determine whether these factors significantly influence duration of admission in regional Australia. This study aimed to evaluate factors associated with a prolonged LOS in patients admitted under General Medicine at Toowoomba Base Hospital (TBH).
Methods: This was a retrospective chart audit of patients admitted under General Medicine at TBH between 1st January and 30th June 2015. Patients admitted under the Medical Admissions and Planning Unit or those admitted for day procedures were excluded. Statistical analysis was performed with SPSS v22.
Results: A total of 835 admissions were reviewed; of these 135 were due to readmissions. The mean total LOS for all patients was 9.11 days (IQR 3.9–10.1 days). Majority of patients were male (51.4%) and lived locally (71.1%). 7.9% lived in a nursing home. 4.8% were indigenous. Majority (71.5%) were discharged to their usual accommodation, whilst 11.6% were transferred to another hospital. A further 4.4% were discharged to a new nursing home and 5.1% died in hospital. Factors associated with a prolonged hospital admission defined as greater than 14 days, include those requiring an intensive care unit (ICU) admission (OR 2.03, 95% CI 1.31–3.14; p=0.002), blood transfusion (OR 3.82, 95% CI 2.07–7.06; p<0.0001), or transthoracic echocardiogram (TTE) (OR 3.14, 95% CI 2.06–4.82; p<0.0001). Additional factors associated with increased LOS include patients awaiting nursing home placements or transfers to another hospital (OR 2.94, 95% CI 2.18–3.96; p<0.0001). There was no significant association between gender, Indigenous status, polypharmacy, co-morbidities or weekend versus weekday admissions and prolonged LOS.
Conclusion: Factors associated with prolonged LOS amongst general medicine patients include ICU admission, use of blood transfusion and TTE and patient awaiting inter-hospital transfer or nursing home placement. Further research is required into these areas to identify measures to improve hospital LOS.