Organizational determinants of hospital stay: establishing the basis of a widespread action on more efficient pathways i
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Organizational determinants of hospital stay: establishing the basis of a widespread action on more efficient pathways in medical units Gianmauro Numico14 · Roberta Bellini1 · Cristian Zanelli1 · Roberto Ippoliti2 · Riccardo Boverio3 · Daniela Kozel4 · Piero Davio5 · Giuseppe Aiosa5 · Aldo Bellora9 · Guido Chichino7 · Luigi Ruiz6 · Marco Ladetto8 · Biagio Polla10 · Marco Manganaro12 · Gianfranco Pistis15 · Carlo Gemme11 · Paolo Stobbione13 · Massimo Desperati4 · Giacomo Centini4 Received: 21 August 2019 / Accepted: 18 December 2019 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Given the high hospital costs, the increasing clinical complexity and the overcrowding of emergency departments, it is crucial to improve the efficiency of medical admissions. We aimed at isolating organizational drivers potentially targetable through a widespread improvement action. We studied all medical admissions in a large tertiary referral hospital from January 1st to December 31st, 2018. Data were retrieved from the administrative database. Available information included age, sex, type (urgent or elective) and Unit of admission, number of internal transfers, main ICD-9 diagnosis, presence of cancer among diagnoses, surgical or medical code, type of discharge, month, day and hour of admission and discharge. National Ministry of Health database was used for comparisons. 8099 admissions were analyzed. Urgent admissions (80.5% of the total) were responsible for longer stays and were the object of the multivariate analysis. The variables most influencing length-of-stay (LOS) were internal transfers and assisted discharge: they contributed, respectively, to 62% and 40% prolongation of LOS. Also, the daily and weekly kinetics of admission accounted for a significant amount of variation in LOS. Long admissions (≥ 30 days) accounted for the 15.5% of total bed availability. Type of discharge and internal transfers were again among the major determinants. A few factors involved in LOS strictly depend on the organizational environment and are potentially modifiable. Re-engineering should be focused on making more efficient internal and external transitions and at ensuring continuity of the clinical process throughout the day and the week. Keywords Length-of stay · Acute-care hospital · Medical admission · Discharge * Gianmauro Numico [email protected] 1
Quality and Management Control Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
2
Department of Business, Administration and Economics, University of Bielefeld, Bielefeld, Deutschland
3
Emergency Department Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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General and Medical Direction, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Internal Medicine Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Neurology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
7
Infectious D
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