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Categorizing Care Delays and Their Impact on Hospital Length of Stay.
Qual Manag Health Care
November 2024
Author Affiliations: Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Nadler, Kisuule, Michtalik, Kantsiper, Harris, and Gundareddy); Carey Business School, Johns Hopkins University, Baltimore, Maryland (Dr Eid); Integrated Hospital Medicine, Memorial Hermann Health System, Houston, Texas (Dr Eid).
Background And Objective: Unnecessary care delays of hospitalized patients increase the risk of hospital-related complications and drive up health care costs. While health systems focus on reducing the length of stay of hospitalized patients, not many studies looked at specific causes of the care delays that prolong length of stay. In this study, we sought to systematically identify and categorize the various care delays that contribute to prolonged length of stay on a hospital medicine service.
View Article and Find Full Text PDFHospital costs and reimbursement for short-stay inpatient versus observation status hospitalizations for children with medical complexity.
J Hosp Med
November 2024
Department of Pediatrics, Division of Hospital Medicine, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA.
Background: There is a lack of uniformity across hospitals in applying inpatient versus observation status for short-stay (<48 h) pediatric hospitalizations, with negative financial implications associated with observation. Children with medical complexity (CMC) represent a growing population and incur high costs of care. The financial implications of inpatient and observation status for CMC have not been studied.
View Article and Find Full Text PDFImpact of the geriatric emergency medicine specialist intervention on final emergency department disposition.
J Am Geriatr Soc
July 2024
Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Background: The Geriatric Emergency Medicine Specialist (GEMS) pilot program is an innovative approach that utilizes geriatric-trained advanced practice providers to facilitate geriatric assessments and care planning for older adults in the emergency department (ED). The objective of this study was to explore the effect of GEMS on the use of observation status and final ED disposition.
Methods: This was a retrospective study under a target trial emulation framework.
The feasibility of emergency department observation units in the management of mild to moderate hyponatremia.
Am J Emerg Med
June 2024
Department of Emergency Medicine, Emory University School of Medicine, 531 Asbury Circle - Annex, Suite N340, Atlanta, Georgia. Electronic address:
Objective: To describe the feasibility of managing hyponatremia patients under outpatient observation status in an academic medical center, and compare outcomes based on the use of an emergency department observation unit (EDOU).
Methods: This is a retrospective cohort study of emergency department hyponatremic patients managed in four hospitals within a large urban academic medical center over 27 months. All patients had an admit-to-observation order, ICD-10 codes for hyponatremia, and mild (130-135 mmol/L) to moderate (121-129 mmol/L) hyponatremia.
Context: Emergency Department (ED) overcrowding is a significant problem worldwide. Many factors contribute to ED overcrowding, including staffing shortages, diagnostic testing delays, and inadequate inpatient beds to meet the demand. ED overcrowding results in patient safety issues like higher inpatient mortality and other negative impacts, such as an increased length of stay (LOS) and an increased trend of leaving the ED before undergoing an evaluation and treatment.
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