Exploring the impact of case mix factors on length of stay to a Complex Discharge Unit across three phases: pre-COVID-19 (2019), during COVID-19 (2021) and late-stage COVID-19 (2023) pandemic.
Tahira Bibi, Mbuotidem Udongwo, Joseph Deegan, Tom Cuddihy, Alanna Crawford, David Griffin, Keneilwe Malomo, Mohammed Tariq Zainal, Patrick Mc Cluskey, Haswadi Hassan, Declan Byrne, Joseph Browne, Ontefetse Ntlholang
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引用次数: 0
Abstract
Background/aims: Subacute complex discharge units (CDUs) offer intermediary person-centred care between acute hospital and community services by providing specialised care for patients with complex medical and functional needs. However, several elements of clinical practice were affected during the COVID-19 pandemic. We aimed to determine the impact of several case mix factors on length of stay and how this impact changed across three phases: pre-COVID-19 (2019), during COVID-19 (2021) and late-stage COVID-19 (2023) in our Complex Discharge Unit.
Materials and methods: Before collecting data, our institution's Research and Innovation Office approved the study (reference number: 8900, on the 23rd of May 2024). All patients (920) who were admitted to our 23-bed Complex Discharge Unit in 2019 (320 patients), 2021(205 patients) and 2023 (395 patients) were evaluated. Data was inspected visually, and variables that predicted length of stay were included in a Poisson regression model to predict the length of stay.
Results: An analysis of the relationship between year, age, medicolegal issues and length of stay, adjusting for several confounding variables (mobility status, healthcare-acquired infection, long-term care status, need for an increase in homecare package and need for a new homecare package) was carried out as there was an interaction. Charlson's Comorbidity (CCI) score and delirium were not predictive of length of stay. Medicolegal issues increased length of stay by a factor of 1.46 (95% CI 1.39-1.52, p < 0.001). For every 1-year increase in age, length of stay increased by a factor of 1.006 in 2019 (95% CI 1.004-1.01, p < 0.001), 0.988 in 2021 (95% CI 0.987-0.99, p < 0.001), and 1.004 in 2023 (95% CI 1.002-1.01, p < 0.001).
Discussion and conclusion: Multimorbidity and delirium did not predict length of stay, while legal issues delayed discharges. On a unit with a baseline longer than average length of stay, there have been progressive improvements in length of stay over time, maybe hastened and retained from lessons learned from the pandemic.
背景/目的:亚急性复杂出院病房(cdu)通过为具有复杂医疗和功能需求的患者提供专门护理,在急性医院和社区服务之间提供以人为中心的中间护理。然而,在2019冠状病毒病大流行期间,临床实践的若干要素受到了影响。我们的目的是确定几个病例组合因素对住院时间的影响,以及这种影响在三个阶段的变化情况:COVID-19前期(2019年)、COVID-19期间(2021年)和COVID-19晚期(2023年)。材料和方法:在收集数据之前,我单位研究与创新办公室批准了这项研究(参考文献号:8900,于2024年5月23日)。我们对2019年(320例)、2021年(205例)和2023年(395例)共23张床位的复杂出院病房收治的所有患者(920例)进行了评估。对数据进行视觉检查,并将预测住院时间的变量纳入泊松回归模型以预测住院时间。结果:分析了年龄、医疗问题和住院时间之间的关系,调整了几个混杂变量(活动状况、卫生保健获得性感染、长期护理状况、需要增加家庭护理包和需要新的家庭护理包),因为存在相互作用。Charlson合并症(CCI)评分和谵妄不能预测住院时间。医学法律问题使住院时间增加了1.46倍(95% CI 1.39-1.52, p)。讨论和结论:多发病和谵妄不能预测住院时间,而法律问题延迟出院。在基线停留时间长于平均停留时间的单位,随着时间的推移,停留时间有所改善,可能是由于从大流行中吸取的教训而加速和保留的。
期刊介绍:
The Irish Journal of Medical Science is the official organ of the Royal Academy of Medicine in Ireland. Established in 1832, this quarterly journal is a contribution to medical science and an ideal forum for the younger medical/scientific professional to enter world literature and an ideal launching platform now, as in the past, for many a young research worker.
The primary role of both the Academy and IJMS is that of providing a forum for the exchange of scientific information and to promote academic discussion, so essential to scientific progress.