Dataset Information

To reduce the average length of stay of patients who are admitted for DA-EPOCH-R chemotherapy regimen.

ABSTRACT: Healthcare institutions are often faced with bed crunch situation. As a result, patients requiring inpatient hospital stay for cancer treatment are delayed and this could lead to compromised overall disease response. Apart from the early discharge of patients to step-down care and explore alternatives of treatment setting, one of the ways to reduce length of stay is to improve on the efficiency of work processes. A baseline study demonstrated that delays in prescribing chemotherapy orders has led to an increased inpatient stay of seven days for a five day treatment regimen. This has profound consequences in terms of costs, patient safety, and utilisation of healthcare resources. A quality improvement project was initiated to review and revise the workflow and processes involved for the entire episode of treatment. A post-implementation review of the interventions showed cost savings, a reduction of average length of stay from seven days to six days (with a total of 28 days saved over six months), and improved patient and staff experience.

SUBMITTER: Lee YM

PROVIDER: S-EPMC4645810 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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To reduce the average length of stay of patients who are admitted for DA-EPOCH-R chemotherapy regimen.

Lee Yee Mei YM

BMJ quality improvement reports 20150410 1

Healthcare institutions are often faced with bed crunch situation. As a result, patients requiring inpatient hospital stay for cancer treatment are delayed and this could lead to compromised overall disease response. Apart from the early discharge of patients to step-down care and explore alternatives of treatment setting, one of the ways to reduce length of stay is to improve on the efficiency of work processes. A baseline study demonstrated that delays in prescribing chemotherapy orders has le ...[more]

PMID: 26734323

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Project description:BackgroundThe Blue Book (2005), recommended guidelines for patients care with fragility fractures. Together with introduction of a National Hip Fracture Database Audit and Best Practice Tariff model to financially incentivise hospitals by payment of a supplement for patients whose care satisfied six clinical standards), have improved hip fracture after-care. However, there is a lack of data-driven evidence to support its effectiveness. We aimed to verify the impact of an orthogeriatric service on hospital length of stay (LOS)-duration from admission to discharge.MethodsWe conducted a repeated cross-sectional study over a 10 year period of older individuals aged ≥ 60 years admitted with hip fractures to a hospital.ResultsAltogether 2798 patients, 741 men and 2057 women (respective mean ages; 80.5 ± 10.6 and 83.2 ± 8.9 years) were admitted from their own homes with a hip fracture and survived to discharge. Compared to 2009-2014, LOS during 2015-2019, when the orthogeriatric service was fully implemented, was shorter for all discharge destinations: 10.4 vs 17.5 days (P < 0.001). Each discharge destination showed reductions: back to own homes, 9.7 vs 17.7 days (P < 0.001); to rehabilitation units: 10.8 vs 13.1 days (P < 0.001); to residential care: 15.4 vs 26.2 days (P = 0.001); or nursing care, 24.4 vs 53.1 days (P < 0.001). During 2009-2014, the risk of staying > 3 weeks in hospital was greater by six-fold and pressure ulcers by three-fold. The number of bed days for every thousand patients per year was also shortened during 2015-2019 by: 1665 days for discharge back to own homes; 469 days with transfer to rehabilitation units; 1258 days for discharge to residential care, and 5465 days to nursing care. Estimated annual savings (2017 costs) per thousand patients after complete establishment of the service was about £2.7 m.ConclusionsImplementation of an orthogeriatric service generated significant reductions in hospital LOS for all patients, with associated cost-savings, especially for those discharged to nursing care.

Project description:Severe stroke patients are known to be associated with larger rehabilitation length of stay (LOS) but other factors besides severity may be contributing. We aim to identify LOS predictors within a population of mostly severe patients and analyze the impact of socioeconomic situation in functionality at admission.A retrospective observational cohort study was conducted including 172 inpatients admitted to a rehabilitation center between 2007 and 2019. Associations with LOS were examined among 30 potential predictor variables using bivariate correlations. Significantly correlated (P < .002, Bonferroni adjustment) variables were entered into 9 different multiple linear regression models.No mild participants were included, 63.37% severe and 36.63% moderate. Most significant LOS determinants were: 1) total functional independence measure (FIM) (P < .001) and hemiparesis (P = .0108) (adjusted R = 0.24), 2) cognitive FIM (P = .002) and severity (P = .001) (adjusted R = 0.22), and 3) home accessibility (P = .043) and hemiparesis (P = 0.032) (adjusted R = 0.19).Known LOS predictors (e.g., depression, ataxia) within the full stroke severities were not found significant in our dataset.Socioeconomic situation was found moderately correlated with total FIM (r = -0.32, P < .0001).When stratifying the patients' socioeconomic situation into mild, important, and severe social risk, their respective median total FIM at admission were 61.5, 50, and 41, with significant differences between the mild and important group (P < .001); also significant differences were found between mild and severe groups (P < .001).A few of the variables identified in the literature as significant predictors of LOS within the full stroke population were also significant for our dataset (National Institutes of Health Stroke Scale, FIM, home accessibility) explaining less than 25% of the LOS variance. Most of the 30 analyzed known predictors were not significant (e.g., depression, age, recurrent stroke, ataxia, orientation, verbal communication, etc) suggesting that factors outside functional, socioeconomic, medical, and demographics not included in this study (e.g., rehabilitation sessions intensity) have important influences on LOS for severe patients.Patients at mild social risk obtained significantly higher total FIM at admission than patients at important and severe social risk. The importance of socioeconomic situation has been scarcely studied in the literature in relation to functionality at admission; our results suggest that it requires to be considered.

Dataset Information

To reduce the average length of stay of patients who are admitted for DA-EPOCH-R chemotherapy regimen.

Publications

To reduce the average length of stay of patients who are admitted for DA-EPOCH-R chemotherapy regimen.

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