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. 2021 Aug 26;6(1):e000744.
doi: 10.1136/tsaco-2021-000744. eCollection 2021.

Improving length of stay on a trauma service

Walter L Biffl  1 , Ning Lu  1 , Peter R Schultz  1 , Jiayan Wang  1 , Matthew R Castelo  1 , Kathryn B Schaffer  1
Affiliations

Improving length of stay on a trauma service

Walter L Biffl et al. Trauma Surg Acute Care Open. .

Abstract

Background: Reducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized patient management would lead to decreased LOS.

Methods: Retrospective analysis of Trauma Registry data compared LOS before (PRE) and after (POST) implementation of standardized processes on a trauma service. Patients were subdivided by age (over and under 65 years). Data were compared using unpaired t-test, χ2 test and analysis of variance tests, where appropriate.

Results: 1613 PRE and 1590 POST patients were compared. Although age and Injury Severity Score were similar, median LOS decreased by 1 day for the group overall (p<0.0001), and for subgroups over and under the age of 65 years (p<0.0001). Older patients were discharged home 13% more often in POST, compared with 4% more for younger patients.

Conclusions: Improved standardization of processes on a trauma service reduced LOS in patients of all ages. A prospective study may identify specific factors associated with prolonged LOS, to allow further improvement.

Level of evidence: III.

Study type: Therapeutic/Care management.

Keywords: geriatrics; length of stay; nurse practitioner.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Number of patients by hospital length of stay (LOS) for all patients, PRE versus POST implementation periods.
Figure 2
Figure 2
Mean Injury Severity Score (ISS) by hospital length of stay (LOS) for all patients, PRE versus POST implementation periods.
Figure 3
Figure 3
Mean Injury Severity Score (ISS) by hospital length of stay (LOS) for patients 64 years and under, PRE versus POST implementation periods.
Figure 4
Figure 4
Mean Injury Severity Score (ISS) by hospital length of stay (LOS) for patients 65 years and older, PRE versus POST implementation periods.
See this image and copyright information in PMC

References

    1. Schwartz DA, Shah AA, Zogg CK, Nicholas LH, Velopulos CG, Efron DT, Schneider EB, Haider AH. Operative delay to laparoscopic cholecystectomy: Racking up the cost of health care. J Trauma Acute Care Surg 2015;79:15–21. 10.1097/TA.0000000000000699 - DOI - PubMed
    1. Regenbogen SE, Cain-Nielsen AH, Norton EC, Chen LM, Birkmeyer JD, Skinner JS. Costs and consequences of early hospital discharge after major inpatient surgery in older adults. JAMA Surg 2017;152:e170123. 10.1001/jamasurg.2017.0123 - DOI - PMC - PubMed
    1. de Jongh MAC, Bosma E, Leenen LPH, Verhofstad MHJ. Increased consumption of hospital resources due to complications: an assessment of costs in a level I trauma center. J Trauma 2011;71:E102–9. 10.1097/TA.0b013e31820e351f - DOI - PubMed
    1. Osler TM, Rogers FB, Hosmer DW. Estimated additional hospital length of stay caused by 40 individual complications in injured patients: an observational study of 204,388 patients. J Trauma Acute Care Surg 2013;74:921–5. 10.1097/TA.0b013e31827e1d5e - DOI - PubMed
    1. MacKenzie EJ, Morris JA, Edelstein SL. Effect of pre-existing disease on length of hospital stay in trauma patients. J Trauma 1989;29:757–65. 10.1097/00005373-198906000-00011 - DOI - PubMed