Hi simsstreet-ga, and thanks for your question.
There are many papers validating the hypothesis that longer hospital
stays result in more complications and higher costs. Traditionally,
the common thinking has been that hospital acquired pneumonias and
other infections are near the top of the list for complications
related to prolonged hospital stays. There are a lot of antibiotic
resistant bacteria in the hospital - the longer someone stays, the
greater their chance of being exposed. Other complications include
medication errors and adverse reactions. The papers below discuss
other results of hospital complications and increased lengths of stay.
Vanhems P. Lepape A. Savey A. Jambou P. Fabry J. Nosocomial pulmonary
infection by antimicrobial-resistant bacteria of patients hospitalized
in intensive care units: risk factors and survival. [Journal Article.
Multicenter Study] Journal of Hospital Infection. 45(2):98-106, 2000
Jun.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11246310&dopt=Citation
A reprint of this article can be requested from Dr. Vanhems in France:
philipva@lyon-sud.univ-lyonl.fr
On page 104, this article states
"Increased length of stay and device durations increased the risk of
NPI-ARB [nosocomial pneumonia infection - antibiotic resistant
bacteria]. This was observed no matter what infection was acquired in
the ICU [1,2,5?7] and included nosocomial pneumonia in the elderly.
[25]"
Figure 1 of the above article shows the probability of remaining free
of pneumonia infection vs. days in the ICU. You can see this figure
here:
http://img254.imageshack.us/img254/9071/nosocomial18sm.png
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Although dated, one of the classic and more comprehensive analyses of
factors affecting the rate of iatrogenic illness and complications,
including length of hospital stay, is the following article:
Steel K, Gertman PM, Crescenzi C, Anderson J. Iatrogenic illness on a
general medical service at a university hospital. 1981. Qual Saf
Health Care. 2004 Feb;13(1):76-80.
Steel K, Gertman PM, Crescenzi C, Anderson J. Iatrogenic illness on a
general medical service at a university hospital. N Engl J Med. 1981
Mar 12;304(11):638-42.
You can find this article free online here:
http://qhc.bmjjournals.com/cgi/content/abstract/13/1/76
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Another historical article of potential interest demonstrated a direct
correlation between length of hospitalization and adverse outcomes:
Schimmel EM. The hazards of hospitalization. 1964.
Qual Saf Health Care. 2003 Feb;12(1):58-63; discussion 63-4.
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Andrews LB, Stocking C, Krizek T, Gottlieb L, Krizek C, Vargish T,
Siegler M. An alternative strategy for studying adverse events in
medical care.
Lancet. 1997 Feb 1;349(9048):309-13.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=9024373&query_hl=4&itool=pubmed_docsum
A reprint of this article can be purchased online via the above link
or requested free from Prof. Lori Andrews at the Chicago-Kent College
of Law:
http://www.kentlaw.edu/faculty/landrews/
landrews@kentlaw.edu
The above article found that longer hospital stays were associated
with a 6% per day increase in adverse outcomes and complications:
"The mean length of stay was 8.8 days for patients without adverse
events and 23.8 days for those with adverse events. The likelihood of
experiencing an adverse event increased about 6% for each day of
hospital stay."
Table 2 of this article describes the categories of adverse events:
"Table 2: Categories of adverse events
Problem area All adverse Serious adverse
events events
Diagnosis 164 (7.5%) 24 (5.2%)
Surgery 230 (10.5%) 91 (19.7%)
Treatment 293 (13.4%) 42 (9.1%)
Monitoring and daily care 639 (29.3%) 79 (17.1%)
Drugs/medication 204 (9.3%) 27 (5.8%)
Nutrition 51 (2.3%) 2 (0.4%)
Anaesthesia 27 (1.2%) 11 (2.4%)
Complications 425 (19.5%) 176 (38.1%)
Other 150 (6.9%) 10 (2.2%)"
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Also of potential interest, the following article looked at the
increase in hospitalization time and cost associated with various
medical errors and adverse events:
Zhan C. Miller MR. Excess length of stay, charges, and mortality
attributable to medical injuries during hospitalization.[see comment].
[Evaluation Studies. Journal Article] JAMA. 290(14):1868-74, 2003 Oct
8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
The free full text of this article is available via the above link
after registration at the JAMA website.
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Here are some additional related articles:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=9024373
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11246310&tool=ExternalSearch
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=14757805
http://qhc.bmjjournals.com/cgi/collection/medical_error_patient_safety
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Search:
Multiple searches through Ovid and Pubmed for medical literature.
Here is an example Google Scholar search:
complications pneumonia infection ("hospital acquired" OR nosocomial)
"length of stay"
http://scholar.google.com/scholar?hl=en&lr=&safe=off&q=complications+pneumonia+infection+%28%22hospital+acquired%22+OR+nosocomial%29+%22length+of+stay%22&as_ylo=2000&as_yhi=&btnG=Search
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I hope this information is helpful. Please feel free to request
clarification prior to rating.
-welte-ga |
