Evidence map›Paper›PMID 34503494›Full record

ArticleBMC health services research2021

The increasing impact of length of stay "outliers" on length of stay at an urban academic hospital.

Andrew H Hughes, David Horrocks, Curtis Leung, Melissa B Richardson, Ann M Sheehy, Charles F S Locke

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Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

13 citing papers in PubMed.

  1. Observational
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  12. Observational
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4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

6 authors.

Andrew H HughesDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ahh@jhmi.edu.
David HorrocksDepartment of Care Coordination/Clinical Resource Management, Johns Hopkins Hospital, 600 N Wolfe St / Blalock 823, Baltimore, MD, 21287, USA.
Curtis LeungDepartment of Care Coordination/Clinical Resource Management, Johns Hopkins Hospital, 600 N Wolfe St / Blalock 823, Baltimore, MD, 21287, USA.
Melissa B RichardsonDepartment of Care Coordination/Clinical Resource Management, Johns Hopkins Hospital, 600 N Wolfe St / Blalock 823, Baltimore, MD, 21287, USA.
Ann M SheehyDepartment of Medicine, Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Charles F S LockeDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAs healthcare systems strive for efficiency, hospital "length of stay outliers" have the potential to significantly impact a hospital's overall utilization. There is a tendency to exclude such "outlier" stays in local quality improvement and data reporting due to their assumed rare occurrence and disproportionate ability to skew mean and other summary data. This study sought to assess the influence of length of stay (LOS) outliers on inpatient length of stay and hospital capacity over a 5-year period at a large urban academic medical center.

methodsFrom January 2014 through December 2019, 169,645 consecutive inpatient cases were analyzed and assigned an expected LOS based on national academic center benchmarks. Cases in the top 1% of national sample LOS by diagnosis were flagged as length of stay outliers.

resultsFrom 2014 to 2019, mean outlier LOS increased (40.98 to 45.11 days), as did inpatient LOS with outliers excluded (5.63 to 6.19 days). Outlier cases increased both in number (from 297 to 412) and as a percent of total discharges (0.98 to 1.56%), and outlier patient days increased from 6.7 to 9.8% of total inpatient plus observation days over the study period.

conclusionsOutlier cases utilize a disproportionate and increasing share of hospital resources and available beds. The current tendency to exclude such outlier stays in data reporting due to assumed rare occurrence may need to be revisited. Outlier stays require distinct and targeted interventions to appropriately reduce length of stay to both improve patient care and maintain hospital capacity.

Indexed as

Hospitals, UrbanQuality ImprovementHumansLength of StayRetrospective StudiesHospital resource utilizationLength of stayOutlier length of stay

Identifiers

PMID34503494
PMCPMC8427900

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.