Length of Stay for Laparoscopic Cholecystectomy

Background: Hospitals seek to maximize efficiency in stabilizing and discharging post-operative patients. The post-operative length of stay (LOS) for laparoscopic cholecystectomy surgeries in the short stay unit of a community hospital in the Portland area varies significantly with an average LOS of 170 minutes. Purpose: The purpose of this study was to isolate factors associated with decreased post-operative LOS for laparoscopic cholecystectomy surgeries to identify procedural changes that would help meet the goal of an average 120 minutes LOS. Methods: EPIC charts of 41 patients who received a laparoscopic cholecystectomy since July 1st 2014 were reviewed for data on specific factors of perioperative care. A literature review was also conducted to gather information on evidence based standards of care. Results: Data showed no differences in post-operative LOS for laparoscopic cholecystectomy patients based on gender, use of a nerve block, or pre-operative Xanax administration. Patients with the shortest LOS, under 120 minutes, received an average of three different antiemetics. Evidence based literature recommends using a combination of antiemetics during surgery to prevent post-operative nausea and vomiting (PONV). Discussion/Recommendation: PONV is a leading factor contributing to increased length of stay. The results of this study, along with evidence-based literature, suggests that a combination of at least three antiemetics during surgery can decrease PONV and thus decrease post-operative LOS for laparoscopic cholecystectomies

Youth Incarceration, Health, and Length of Stay

For youth from marginalized communities, the pathway into the juvenile justice system occurs against a backdrop of disproportionately high levels of stress, complex trauma, and adverse childhood experiences. Despite overall reductions in the percentage of youth in confinement from recent state-level reforms, the lengths of stay for many youth often exceed evidence-based timelines, as well as a state’s own guidelines and criteria. This occurs despite a large and growing body of empirical research that documents the health status of system-involved youth and the association between incarceration during adolescence and the range of subsequent health and mental health outcomes in adulthood. Presently, advocates for length of stay reform rely on two primary arguments: recidivism and costs of confinement. This Article argues that this framing misses a critical component, as a better understanding of the linkages between length of stay, health, and mental health are essential for achieving the foundational goals of the juvenile justice system—i.e., rehabilitation, decreased recidivism, and improved community reintegration. Through an examination of juvenile sentencing typologies, release decision-making, and empirical research on the health and mental health needs of at-risk and system-involved youth, this Article aims to fill this gap and expand current lines of debate, discourse, and advocacy.

The determinants of length of stay in the Azores : a count model approach

This paper employs count data models to estimate the determinants of length of stay, as count data models naturally lend themselves to overcome the censoring and truncation data issues associated with the non-negative, integer nature of length of stay. This paper employs a rich micro data set gathered through questionnaires ministered to a representative sample of tourists departing from the Azores: the fastest growing touristic region in Portugal. It is found that sociodemographic profiles, such as nationality and Azorean ascendancy, and trip attributes, such as repeat visitation rates and type of flight, are important determinants of length of stay. In addition, it is found that destination image and attitudes regarding environmental initiatives, constructed from a factor analysis exercise, also influence length of stay. In particular, the results suggest that marketing strategies that promote the Azores for its nature, landscape, remoteness, weather and safety may increase length of stay, whereas cultural heritage has the opposite effect.N/

Length of Stay after Vaginal Birth: Sociodemographic and Readiness-for-Discharge Factors

Background: The impact of reductions in postpartum length of stay have been widely reported, but factors influencing length of hospital stay after vaginal birth have received less attention. The study purpose was to compare the sociodemographic characteristics and readiness for discharge of new mothers and their newborns at 3 discharge time intervals, and to determine which variables were associated with postpartum length of stay. Methods: The study sample comprised 1,192 mothers who were discharged within 2 postpartum days after uncomplicated vaginal birth at a tertiary perinatal center in the midwestern United States. The sample was divided into 3 postpartum length-of-stay groups: group 1 (18–30 hr), group 2 (31–42 hr), and group 3 (43–54 hr). Sociodemographic and readiness-for-discharge data were collected by self-report and from a computerized hospital information system. Measures of readiness for discharge included perceived readiness (single item and Readiness for Discharge After Birth Scale), documented maternal and neonatal clinical problems, and feeding method. Results: Compared with other groups, the longest length-of-stay group was older; of higher socioeconomic status and education; and with more primiparous, breastfeeding, white, married mothers who were living with the baby’s father, had adequate home help, and had a private payor source. This group also reported greater readiness for discharge, but their newborns had more documented clinical problems during the postbirth hospitalization. In logistic regression modeling, earlier discharge was associated with young age, multiparity, public payor source, low socioeconomic status, lack of readiness for discharge, bottle-feeding, and absence of a neonatal clinical problem. Conclusions: Sociodemographic chracteristics and readiness for discharge (clinical and perceived) were associated with length of postpartum hospital stay. Length of stay is an outcome of a complex interface between patient, provider, and payor influences on discharge timing that requires additional study. Including perceived readiness for discharge in clinical discharge criteria will add an important dimension to assessment of readiness for discharge after birth

Survival Models of Community Tenure and Length of Hospital Stay for the Seriously Mentally Ill: A 10-year Perspective

Objective: To examine the effects of personal and community characteristics, specifically race and rurality, on lengths of state psychiatric hospital and community stays using maximum likelihood survival analysis with a special emphasis on change over a ten year period of time. Data Sources: We used the administrative data of the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) from 1982- 1991 and the Area Resources File (ARF). Given these two sources, we constructed a history file for each individual who entered the state psychiatric system over the ten year period. Histories included demographic, treatment, and community characteristics. Study Design: We used a longitudinal, population-based design with maximum likelihood estimation of survival models. We presented a random effects model with unobserved heterogeneity that was independent of observed covariates. The key dependent variables were lengths of inpatient stay and subsequent length of community stay. Explanatory variables measured personal, diagnostic, and community characteristics, as well as controls for calendar time. Data Collection: This study used secondary, administrative and health planning data. Principal Findings: African-American clients leave the community more quickly than whites. After controlling for other characteristics, however, race does not affect hospital length of stay. Rurality does not affect length of community stays once other personal and community characteristics are controlled for. However, people from rural areas have longer hospital stays even after controlling for personal and community characteristics. The effects of time are significantly smaller than expected. Diagnostic composition effects and a decrease in the rate of first inpatient admissions explain part of this reduced impact of time. We also find strong evidence for the existence of unobserved heterogeneity in both types of stays and adjust for this in our final models. Conclusions: Our results show that information on client characteristics available from inpatient stay records is useful in predicting not only the length of inpatient stay but also the length of the subsequent community stay. This information can be used to target increased discharge planning for those at risk of more rapid readmission to inpatient care. Correlation across observed and unobserved factors affecting length of stay has significant effects on the measurement of relationships between individual factors and lengths of stay. Thus, it is important to control for both observed and unobserved factors in estimation.community tenure, length of psychiatric inpatient stay, survival analysis, state psychiatric hospital, maximum likelihood estimation

Reallocation of beds to reduce waiting time for cardiac surgery

Waiting time for cardiac surgery is a significant problem in the current medical world. The fact that patients length of stay varies considerably makes effective hospital operation a hard job. In this paper, the patients length of stay is analyzed. Three scenarios for hospital management are presented and evaluated in two ways. First, the theoretical number of beds needed in each of these scenarios is analyzed using techniques from Markov chain theory. This analysis does not include the important variability in length of stay. Therefore, the second evaluation is based on simulation experiments to further investigate the variability. The aim of the analyses is to look at unused bed capacity in the hospital wards. By knowing the size of the unused bed capacity, it is possible to come to a more efficient reallocation of the beds. The results presented in this paper provide some insight in the relation between patients length of stay, bed availability and hospital waiting lists. Finally, some ideas are raised as discussion points for further research.

HIV AIDS Length of Stay Outliers

AbstractCosts with HIV/AIDS hospitalizations are one of the major financial burdens on healthcare systems worldwide. In Portugal, hospitalizations related to HIV infection are some of the most expensive and the second major diagnosis category, and also accounts for the greatest average length of stay. As a result, it is crucial to understand and identify HIV/AIDS hospital length of stay outliers. The objective of this study is to analyse HIV/AIDS length of stay high outliers during five consecutive years (2009-2013) and to identify its determinants for a specific HIV/AIDS diagnosis related group. To attain these objectives we will use a logistic regression model with random effects