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How much do operational processes affect hospital inpatient discharge rates?

J Public Health (Oxf). 2009 Dec;31(4):546-53

Authors: Wong H, Wu RC, Tomlinson G, Caesar M, Abrams H, Carter MW, Morra D

BACKGROUND: The objective of this study is to determine the effect of day of the week, holiday, team admission and rotation schedules, individual attending physicians and their length of coverage on daily team discharge rates. METHODS: We conducted a retrospective analysis of the General Internal Medicine (GIM) inpatient service at our institution for years 2005 and 2006, which included 5088 patients under GIM care. RESULTS: Weekend discharge rate was more than 50% lower compared with reference rates whereas Friday rates were 24% higher. Holiday Monday discharge rates were 65% lower than regular Mondays, with an increase in pre-holiday discharge rates. Teams that were on-call or that were on call the next day had 15% higher discharge rates compared with reference whereas teams that were post-call had 20% lower rates. Individual attending physicians and length of attending coverage contributed small variations in discharge rates. Resident scheduling was not a significant predictor of discharge rates. CONCLUSIONS: Day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Introducing greater holiday and weekend capacity as well as reorganizing internal processes such as admitting and attending schedules may potentially optimize discharge rates.

PMID: 19465455 [PubMed - indexed for MEDLINE]

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Relationship between body mass index and length of hospital stay for gallbladder disease.

J Public Health (Oxf). 2008 Jun;30(2):161-6

Authors: Liu B, Balkwill A, Spencer E, Beral V,

BACKGROUND: Obesity increases the risk of hospital admission for gallbladder disease but its impact on the length of hospital stay is largely unknown. METHODS: Prospective population-based study of 1.3 million women aged 56 years on average, recruited from 1996 to 2001 in England and Scotland and followed-up through NHS hospital admission record databases for gallbladder disease (cholelithiasis, cholecystitis, cholecystectomy) over a total of 7.8 million person-years. RESULTS: During follow-up, 24 953 women were admitted with gallbladder disease, 87% who had a cholecystectomy. After adjusting for age, socioeconomic status and other factors, women with higher BMI at recruitment to the study were more likely to be admitted and spend more days in hospital. For 1000 person-years of follow-up, women in BMI categories of 18.5-24.9, 25-29.9, 30-39.9, 40+ kg/m(2) spent, respectively, 16.5[16.0-17.0], 28.6[28.3-28.8], 44.0[43.4-44.5] and 49.4[45.7-53.0] days in hospital for gallbladder disease. CONCLUSION: On the basis of these estimates, over a quarter of all the days in hospital for gallbladder disease in middle-aged women can be attributed to obesity.

PMID: 18308742 [PubMed - indexed for MEDLINE]

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