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Length of stay (LOS) is the duration of a single episode of hospitalization. Inpatient days are calculated by subtracting day of admission from day of discharge.
| | This article needs additional citations for verification .(February 2017) |
Length of stay (LOS) is the duration of a single episode of hospitalization. Inpatient days are calculated by subtracting day of admission from day of discharge.
A common statistic associated with length of stay is the average length of stay (ALOS), a mean calculated by dividing the sum of inpatient days by the number of patients admissions with the same diagnosis-related group classification. A variation in the calculation of ALOS can be to consider only length of stay during the period under analysis.
Length of stay is typically highly skewed and so statistical approaches taking that into account are recommended. [1] While the mean length of stay is useful from the point of view of costs, it may be a poor statistic in terms of representing a typical length of stay, and the median may be preferred.
It is useful to be able to predict an individual's expected length of stay or to model length of stay to determine factors that affect it. Various analyses have sought to model length of stay in different condition contexts. This has usually been done with regression models, but Markov chain methods have also been applied. [2] [3] Within regression approaches, linear, log-normal and logistic regression approaches have been applied, but have been criticised by other researchers. [1] [3] Carter & Potts (2014) instead recommend use of negative binomial regression. [1]
Length of stay is commonly used as a quality metric. [4] The prospective payment system in U.S. Medicare for reimbursing hospital care promotes shorter length of stay by paying the same amount for procedures, regardless of days spent in the hospital.
Additionally, length of stay in hospital can be linked to additional quality metrics such as patient satisfaction with health professionals, reduction in hospital readmissions, and even mortality. Discharge planning processes can be effective in reducing a patient's length of stay in hospital. For example, for older people admitted with a medical condition, discharge planning has been shown to improve satisfaction, reduce the overall length of stay, and within 3-month period reduce the likelihood of readmission. [4]
The term "average length of stay" (ALOS) is also applicable to other industries, e.g. entertainment, event marketing, trade show and leisure. ALOS is used to determine the length of time an attendee is expected to spend on a site or in a venue and is part of the calculation used to determine the gross sales potential for selling space to vendors etc. and affects everything from parking to sanitation, staffing and food and beverage. Almost all operational aspects can be altered by an attendee's ALOS.
Outpatient commitment—also called assisted outpatient treatment (AOT) or community treatment orders (CTO)—refers to a civil court procedure wherein a legal process orders an individual diagnosed with a severe mental disorder to adhere to an outpatient treatment plan designed to prevent further deterioration or recurrence that is harmful to themselves or others.
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center.
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care provider.
Hospital medicine is a medical specialty that exists in some countries as a branch of family medicine or internal medicine, dealing with the care of acutely ill hospitalized patients. Physicians whose primary professional focus is caring for hospitalized patients only while they are in the hospital are called hospitalists. Originating in the United States, this type of medical practice has extended into Australia and Canada. The vast majority of physicians who refer to themselves as hospitalists focus their practice upon hospitalized patients. Hospitalists are not necessarily required to have separate board certification in hospital medicine.
Against medical advice (AMA), sometimes known as discharge against medical advice (DAMA), is a term used in health care institutions when a patient leaves a hospital against the advice of their doctor. While leaving before a medically specified endpoint may not promote the patient's health above their other values, there is widespread ethical and legal consensus that competent patients are entitled to decline recommended treatment.
In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.
Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry, is the branch of psychiatry that specialises in the interface between general medicine/pediatrics and psychiatry, usually taking place in a hospital or medical setting. The role of the consultation-liaison psychiatrist is to see patients with comorbid medical conditions at the request of the treating medical or surgical consultant or team. Consultation-liaison psychiatry has areas of overlap with other disciplines including psychosomatic medicine, health psychology and neuropsychiatry.
Predictive analytics is a form of business analytics applying machine learning to generate a predictive model for certain business applications. As such, it encompasses a variety of statistical techniques from predictive modeling and machine learning that analyze current and historical facts to make predictions about future or otherwise unknown events. It represents a major subset of machine learning applications; in some contexts, it is synonymous with machine learning.
Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma.
The patient experience describes an individual's experience of illness/injury and how healthcare treats them. Increasing focus on patient experience is part of a move towards patient-centered care. It is often operationalised through metrics, a trend related to consumerism and New Managerialism.
Early postnatal hospital discharge generally refers to the postpartum hospital discharge of the mother and newborn within 48 hours. The duration of what is considered "early discharge" varies between countries from 12 to 72 hours due to the differences in average duration of hospital stay. The World Health Organisation (WHO) recommends healthy mothers and newborns following an uncomplicated vaginal delivery at a health facility to stay and receive care at the facility for at least 24 hours after delivery. This recommendation is based on findings which suggest that the first 24 hours after giving birth poses the greatest risks for both the mother and newborn.
The Society of Hospital Medicine (SHM) is a membership society for hospitalists, physicians, and other caregivers who practice the specialty of hospital medicine.
The Healthcare Cost and Utilization Project is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
Bundled payment is the reimbursement of health care providers "on the basis of expected costs for clinically-defined episodes of care." It has been described as "a middle ground" between fee-for-service reimbursement and capitation, given that risk is shared between payer and provider. Bundled payments have been proposed in the health care reform debate in the United States as a strategy for reducing health care costs, especially during the Obama administration (2009–2016). Commercial payers have shown interest in bundled payments in order to reduce costs. In 2012, it was estimated that approximately one-third of the United States healthcare reimbursement used bundled methodology.
In statistics, the Sobel test is a method of testing the significance of a mediation effect. The test is based on the work of Michael E. Sobel, and is an application of the delta method. In mediation, the relationship between the independent variable and the dependent variable is hypothesized to be an indirect effect that exists due to the influence of a third variable. As a result when the mediator is included in a regression analysis model with the independent variable, the effect of the independent variable is reduced and the effect of the mediator remains significant. The Sobel test is basically a specialized t test that provides a method to determine whether the reduction in the effect of the independent variable, after including the mediator in the model, is a significant reduction and therefore whether the mediation effect is statistically significant.
The Trauma Quality Improvement Program (TQIP) was initiated in 2008 by the American College of Surgeons Committee on Trauma. Its aim is to provide risk-adjusted data for the purpose of reducing variability in adult trauma outcomes and offering best practice guidelines to improve trauma care. TQIP makes use of national data to allows hospitals to objectively evaluate their trauma centers' performance relative to other hospitals. TQIP's administrative costs are less than those of other programs, making it an accessible tool for assessing performance and enhancing quality of trauma care.
Patient satisfaction is a measure of the extent to which a patient is content with the health care which they received from their health care provider.
In healthcare, the weekend effect is the finding of a difference in mortality rate for patients admitted to hospital for treatment at the weekend compared to those admitted on a weekday. The effects of the weekend on patient outcomes has been a concern since the late 1970s, and a 'weekend effect' is now well documented. Although this is a controversial area, the balance of opinion is that the weekend have a deleterious effect on patient care —based on the larger studies that have been carried out. Variations in the outcomes for patients treated for many acute and chronic conditions have been studied.
A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems. Generally, higher readmission rate indicates ineffectiveness of treatment during past hospitalizations. Hospital readmission rates were formally included in reimbursement decisions for the Centers for Medicare and Medicaid Services (CMS) as part of the Patient Protection and Affordable Care Act (ACA) of 2010, which penalizes health systems with higher than expected readmission rates through the Hospital Readmission Reduction Program. Since the inception of this penalty, there have been other programs that have been introduced, with the aim to decrease hospital readmission. The Community Based Care Transition Program, Independence At Home Demonstration Program, and Bundled Payments for Care Improvement Initiative are all examples of these programs. While many time frames have been used historically, the most common time frame is within 30 days of discharge, and this is what CMS uses.
In the domain of hospital medicine, interdisciplinary bedside rounds are a collaborative approach to patient care that involves the participation of the bedside nurse, primary provider, and the patient. They are often joined by family members and allied health professionals such as the patient's pharmacist and case manager.
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