Organizational determinants of hospital stay: increasing hospital efficiency
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IM - COMMENTARY
Organizational determinants of hospital stay: increasing hospital efficiency Fernando‑Miguel Gamboa‑Antiñolo1 Received: 22 February 2020 / Accepted: 26 February 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Hospitalization is the main category of health-care spending. Improving the efficiency of hospital care is a priority. Prolonged hospital stay is a global concern, as it generates negative effects on patients and the health system, with increased costs, poor accessibility to hospitalization services, saturation of emergencies and risk of adverse effects. It is crucial to improve the efficiency of medical income [1]. The appropriate length of hospital stay, understood as one that fits the necessary days of admission to a hospital unit, is not clearly defined for each process and, in fact, there is great variability between different continents. It is essential to identify the determinants of the length of hospital stay to improve the selection criteria of those who are candidates for admission to the different units, identify a subgroup of candidate patients to apply specific programs to reduce the length of hospital stay, and consequently improve health outcomes and the costs associated with hospitalization. Hospital stay in medical units continues to depend on clinical and organizational variability. Inadequate prolonged patient stays are a risk factor for adverse events and worse health [2]. In a recent study, hospital stays in medical services were analyzed [1]. Some factors involved depend strictly on the organizational environment and are potentially modifiable. There is room for improvement, the average stay in medical units can be further reduced through a plan of interventions focused on discharge. The high delay is avoidable [3]. Part of the variability depends on whether or not the clinical pathways are standardized [4]. There are some factors that are not modifiable: clinical complexity (indirectly suggested by age, admission unit, diagnostic code) or if admission is scheduled or urgent. However, there are factors that depend strictly on the organizational process, represent differences in the style of practice [5] and are potentially improvable [3]. * Fernando‑Miguel Gamboa‑Antiñolo [email protected]; [email protected] 1
Servicio de Medicina Interna, Hospital de Valme, Universidad de Sevilla, Ctra Cadiz s/n, 41014 Sevilla, Spain
Reengineering should focus on making transitions more efficient and to ensure the continuity of the clinical process. A “risk adjustment” has been proposed, using the method of diagnosis-related groups (drg) and an appropriate simulation methodology. The factor most frequently found in the literature, which prolongs hospital stay, is the delay in performing surgical and diagnostic procedures, followed by the need for attention at another level of complexity, socio-family status and patient age [6]. From a clinical management point of view, it is useful to identify the “extended stay patient” prior to the order of admission,
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