Longer length of stay can cut readmissions

Despite initiatives to shorten length of stay, new research indicates the longer a patient is in the hospital, the risk of the patient readmitting goes down, heartwire reported.

For every extra day that an acute heart failure patient stayed in the hospital after admission, there was a "a modest but significant" drop in the 30-day readmission rate (p=0.002), according to a study of nearly 7,000 patients across the globe. Researchers with the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) looked at 27 countries. In the United States, the mean length of stay was 6.1 days, and the 30-day readmission rate was 17.8 percent.

Researchers attribute the correlations between longer length of stay and reduced readmissions to extra care during those additional days in the hospital.

"Patient and family education, medication reconciliation, deployment of disease management programs, coordination of ambulatory care services, and potentially even remote monitoring are all things that could happen on an additional day in the hospital," lead author Zubin Eapen, Duke Clinical Research Institute in Durham, N.C., told heartwire. "Doing more to coordinate care as the patient goes back home would be not only beneficial from a policy standpoint, but certainly important in terms of providing patient-centered care," he said.

The study may seem counterintuitive, as many hospitals push their clinicians to carefully monitor length of stay not only to reduce the costs, but to reduce the chance of patients getting infections. For example, a study in Medical Care journal last year found that the longer a patient stayed in the hospital, the chances of him or her acquiring an infection, having an adverse drug reaction, or developing a pressure ulcer go up. On average, every night a patient stays in the hospital increases his or her chance of infection by 1.6 percent, adverse drug reaction by 0.5 percent (because of errors or unknown allergy) and pressure ulcer by 0.5 percent (from not being moved enough).

The studies may point to the delicate balance of controlling readmissions with proper patient care in the appropriate amount of time.

For more information:
- read the heartwire article (registration required)

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