Variations in length of stay of inpatients with COVID-19: A nationwide test of the new model of care under vision 2030 in Saudi Arabia

Abstract

Objective: The coronavirus disease 2019 (COVID-19) has impacted the Kingdom of Saudi Arabia (KSA) as it has other nations. However, length of stay (LOS), as a healthcare quality indicator, has not been examined across the healthcare regions in the KSA. Therefore, this study aimed to examine factors associated with LOS to better understand the Saudi Health System's performance in response to the COVID-19 pandemic in the newly suggested five Saudi regional business units (BUs).

Methods: A retrospective study was conducted using Ministry of Health (MOH) data on hospital LOS during the period from March to mid-July 2020. Participants were adult inpatients (18 years or older) with confirmed COVID-19 (n = 1743 patients). The 13 regions of the KSA were united into the defined five regional BUs during the reorganization of the health system. Covariates included demographics such as age and sex, comorbidities, and complications of COVID-19. A multiple linear regression with stepwise forward selection was used to model LOS for other explanatory variables associated with LOS, including demographic, comorbidities, and complications.

Results: The mean LOS was 11.85 days which differed significantly across the BUs, ranging from 9.3 days to 13.3 days (p value < 0.001). BUs differed significantly in LOS for transferred patients but not for patients in the intensive care unit (ICU) or those who died in-hospital. The multiple regression analysis revealed that the LOS for inpatients admitted in the Eastern and Southern BUs was significantly shorter than for those in the Central BU. (p value < 0.001). Admission to the ICU was associated with lengthier stays (p value < 0.0001). Factors significantly associated with shorter stays (compared to the reference), were being Saudi, death during admission, and patients referred to another hospital (p value < 0.05).

Conclusion: The LOS for patients with COVID-19 differed across the proposed regional healthcare BUs, suggesting regional differences in quality of care under the reorganization of the national health system. Since patient and disease characteristics did not explain these findings, differences in staffing and other resources need to be examined to develop interventions.

Keywords: ARDS, Acute Respiratory Distress Syndrome; CI, Confidence interval; COVID-19; COVID-19, Coronavirus disease 2019; GIT, Gastrointestinal tract; Hospital admission; ICU, Intensive care unit; KSA, Kingdom of Saudi Arabia; LOS, Length of stay; Length of stay; MOC, Model of care; MOH, Ministry of Health; OR, Odds Ratio; Occupational and environmental health; Saudi Arabia; Vision 2030.

Fig. 1

The five proposed business units in the KSA. C = Central unit; W = Western unit; E = Eastern unit; S = Southern unit; N = Northern unit.

Fig. 2

Rates of length of stay in the current 13 administrative region model and prospective five administrative unit model of the Kingdom of Saudi Arabia.