Clinical Analysis and Management of Long-Stay Patients

BACKGROUND: Worldwide, a certain proportion of patients stay for long periods. Reduction of length of stay is a critical intervention to optimize in-hospital resource utilization. Length of stay itself is a reliable quality index for healthcare systems. Interventions to reduce long hospital stays require understanding organizational and individual factors that affect the length of stay. The purposes of this study are to attempt to reduce long stays (defined as >30 days) by identifying the causes and preventing such situations. METHODS: This was a retrospective observational study of patients who stayed in the hospital for long periods (>30 days) between 1 January 2018 and 31 December 2018. We identified subgroups of patients with long stays, evaluated their associations with baseline variables, relevant discharge departments, and causes of long stays. We proposed improvement plans. RESULTS: There were 446 long-stay patients (mean age 66.7 years; 37.7% females), including 158 undergoing prolonged mechanical ventilation, 109 with diseases requiring hospitalization, 93 due to nosocomial infection, 31 with delayed discharge, 20 with iatrogenic complications, and 35 patients with long stays for various causes. There were 9331 hospital days associated with 158 patients with prolonged mechanical ventilation. The number of hospital days for those undergoing prolonged mechanical ventilation was significantly different from that of patients who did not undergo prolonged mechanical ventilation. Depending on the causes of long stay, we could reduce the length of stay in 188 (42.1%) of patients using an aggressive management strategy. CONCLUSIONS: Setting a ventilator weaned unit for prolonged mechanical ventilation patients in a tertiary-level hospital is essential to reduce long stay of intensive care unit. Aggressive management strategies can reduce long stays.