Impact of a Repatriation Program Between Quaternary and Community Hospitals.

BACKGROUND: Capacity challenges at quaternary hospitals cause delays or denials in patient transfers from community hospitals that can compromise quality and safety. Repatriation is an innovative approach to increase capacity at the quaternary hospital by transferring a patient back to their originating community hospital after the quaternary portion of their care is completed. METHODS: A repatriation program was implemented at a large quaternary care teaching hospital over a one-year period (2020 to 2021). The authors characterized the rate of successful repatriation and associated patient characteristics, determined the impact on quaternary hospital capacity in terms of bed days saved, and estimated the resultant number of backfilled admissions that could be accommodated. The research team also monitored the rate of readmissions for repatriations back to the quaternary hospital. RESULTS: Overall, 215 repatriations were attempted, and 103 (47.5%) were successful. The most common diagnoses were sepsis (13, 12.6%), stroke (12, 11.7%), intracranial bleed (10, 9.7%), gastrointestinal perforation/obstruction (9, 8.7%), and trauma (9, 8.7%). The median length of stay at the quaternary hospital was 13 days (interquartile range [IQR] 7-20) and 12 days (IQR 4-26) at the community hospital. There were 2,842 bed days saved at the quaternary hospital, with a backfill opportunity of 431 admissions. The readmission rate to the quaternary hospital was 1.9%. CONCLUSION: By dynamically matching patient need with hospital capability at different phases of the patient's care, Repatriation can save bed days at the quaternary hospital, creating capacity to improve access for patients needing timely transfer. The low observed readmission rate suggests that repatriation is safe.

Discharge to post-acute care and other predictors of prolonged length of stay during the initial COVID-19 surge: a single site analysis.

BACKGROUND: During the initial surge of coronavirus disease 2019 (COVID-19), health-care utilization fluctuated dramatically, straining acute hospital capacity across the USA and potentially contributing to excess mortality. METHODS: This was an observational retrospective study of patients with COVID-19 admitted to a large US urban academic medical center during a 12-week COVID-19 surge in the Spring of 2020. We describe patterns in length of stay (LOS) over time. Our outcome of interest was prolonged LOS (PLOS), which we defined as 7 or more days. We performed univariate analyses of patient characteristics, clinical outcomes and discharge disposition to evaluate the association of each variable with PLOS and developed a final multivariate model via backward elimination, wherein all variables with a P-value above 0.05 were eliminated in a stepwise fashion. RESULTS: The cohort included 1366 patients, of whom 13% died and 29% were readmitted within 30 days. The LOS (mean: 12.6) fell over time (P < 0.0001). Predictors of PLOS included discharge to a post-acute care (PAC) facility (odds ratio [OR]: 11.9, 95% confidence interval [CI] 2.6-54.0), uninsured status (OR 3.2, CI 1.1-9.1) and requiring intensive care and intubation (OR 18.4, CI 11.5-29.6). Patients had a higher readmission rate if discharged to PAC facilities (40%) or home with home health agency (HHA) services (38%) as compared to patients discharged home without HHA services (26%) (P < 0.0001). CONCLUSION: Patients hospitalized with COVID-19 during a US COVID-19 surge had a PLOS and high readmission rate. Lack of insurance, an intensive care unit stay and a decision to discharge to a PAC facility were associated with a PLOS. Efforts to decrease LOS and optimize hospital capacity during COVID-19 surges may benefit from focusing on increasing PAC and HHA capacity and resources.

A multidisciplinary approach to decreasing length of stay in acute care surgery patients.

AIM: To decrease hospital length of stay in acute care surgery patients. DESIGN: An observational cohort quality improvement project at a single tertiary referral centre. METHODS: A multidisciplinary team of physicians, nurses, case managers, and physical and occupational therapists was created to identify patients at risk for prolonged length of stay and implement weekly multidisciplinary rounding, with a systematic method of tracking progress in real time. The main outcome measure was hospital length of stay. The observed/expected ratios for length of stay 2 years before (2012-2014) and after (2014-2016) the intervention were compared. RESULTS: A total of 6,120 patients was analysed. Early identification and action on barriers to discharge created a significant decrease in risk-adjusted acute care surgery patient days per year (96 days) with limited added cost (1-2 hr per week). Patients discharged to home with or without services benefited most. CONCLUSION: Decreasing length of stay in acute care surgery patients is possible without adding a significant burden to healthcare providers. IMPACT: We describe a comprehensive, multidisciplinary initiative to decrease the length of stay of acute care surgery patients. Institutions can use existing resources in a sustainable manner to create a significant decrease in patient days per year with limited added cost. REGISTRATION: https://osf.io/zfc3t.