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Examining Length of Stay in 8-Hour Shifts

In previous research, studies have documented significant links between length of stay (LOS) over 24-hour periods and hospital occupancy, the number of ED admissions, and other factors. In the May 2012 Western Journal of Emergency Medicine, my colleagues and I published a study that looked at LOS in more discreet time periods than what earlier analyses have reported. We did this because ED crowding and volume can vary greatly during a given 24-hour period. We wanted to find out which factors were associated with LOS and whether this relationship was present during all or only specific 8-hour shifts. In our analysis, independent variables were measured during three 8-hour shifts. Shift 1 was from 7:00 am to 3:00 pm, shift 2 was from 3:00 pm to 11:00 pm, and shift 3 was from 11:00 pm to 7:00 am. For each shift, the numbers of ED nurses on duty, discharges, discharges on the previous shift, resuscitation cases, admissions and ICU admissions, and LOS on the previous shift, were measured. For each 24- hour period, the numbers of elective surgical admissions and hospital occupancy were measured, since these could not be measured in 8-hour time intervals. ED Length of Stay: Roles of Occupancy & Admissions On all three shifts, LOS increased by about 1 minute for each additional 1% increase in hospital occupancy. The mean hospital occupancy in our study was 94.9%; considering this high level of demand for inpatient beds, even a 1% increase in occupancy can lead to significant delays. The demand for inpatient beds often exceeds 100% capacity during the late morning and early afternoon hours on weekdays. To...

The Need for Ensuring Medication Continuity

Discontinuation of medications with proven efficacy for treating chronic diseases is a critical problem, especially during or following hospitalization. Research has suggested that transitions in care, specifically those that occur during an ICU admission, may be partly to blame because they can result in medical errors. Examining Transitions in Care In a study published in the August 2011 JAMA, Chaim M. Bell, MD, PhD, and colleagues set out to evaluate rates of unintentional discontinuation of medication following hospitalization. Rates of medication discontinuation were compared across three groups: 1) patients admitted to the ICU, 2) patients hospitalized without ICU admission, and 3) non-hospitalized patients (controls). “We evaluated the effect of hospitalization and ICU admission on discontinuation of five medication groups with strong benefit-to-risk ratios,” explains Dr. Bell. “This is also one of the first studies to our knowledge that assesses the impact of discontinuation on outcomes at 1 year after discharge.” Dr. Bell’s population-based cohort study analyzed medical records on almost 400,000 elderly patients hospitalized between 1997 and 2009 who were taking at least one of five medications: Statins. Antiplatelet or anticoagulant agents. Levothyroxine. Respiratory inhalers. Gastric acid–suppressing drugs. Patients were required to demonstrate a minimum of 1 year of continuous use of the medication for study entry, thus minimizing the possibility of deliberate medication withdrawals. At 90 days after study participants were discharged, potentially unintentional discontinuation of medication was assessed. The authors also tracked deaths, hospitalizations, and ED visits up to 1 year after hospital discharge. New Findings on Medication Discontinuation In the JAMA article, the investigators found that hospitalization was associated with an increased risk of medication discontinuation...
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