Article Figures & Tables
Tables
- Table 1:
Patient characteristics associated with duration of stay after admission to general internal medicine
Characteristic Duration of stay; no. (%) of patients* p value‡ < 24 h
n = 424524–72 h
n = 13 442> 72 h†
n = 38 368Age, yr, median (IQR) 63 (45–78) 67 (50–81) 74 (59–84) < 0.001 Female sex 2155 (50.8) 6722 (50.0) 19 026 (49.6) 0.3 Charlson Comorbidity Index score < 0.001 0 1846 (43.5) 4666 (34.7) 8809 (23.0) 1 962 (22.7) 3061 (22.8) 7737 (20.2) 2 557 (13.1) 2210 (16.4) 6785 (17.7) ≥ 3 880 (20.7) 3505 (26.1) 15 037 (39.2) Transported via ambulance 1531 (36.1) 5700 (42.4) 21 533 (56.1) < 0.001 Admitted to general internal medicine at a study site in prior 30 d* 372 (8.8) 1283 (9.5) 5315 (13.8) < 0.001 Laboratory-based Acute Physiology Score, mean ± SD 13.0 ± 12.4 16.3 ± 13.9 21.4 ± 17.1 < 0.001 Admitted on weekend 929 (21.9) 3516 (26.2) 10 152 (26.4) < 0.001 Time of admission < 0.001 Day (0800–1659:59) 398 (9.4) 2832 (21.1) 8398 (21.9) Evening (1700–2400) 1795 (42.3) 5156 (38.4) 14 828 (38.6) Night (0000:01–0759:59) 2052 (48.3) 5454 (40.6) 15 142 (39.5) Note: IQR = interquartile range, SD = standard deviation.
↵* Except where noted otherwise.
↵† Patients who left hospital against medical advice, died or were transferred to another acute inpatient, rehabilitation or palliative care facility were categorized as having a stay of more than 72 hours.
↵‡ χ2 analysis for categorical variables, Kruskall–Wallis test for continuous variables.
- Table 2:
Univariate and multivariable regression models of patient, physician and situational characteristics associated with a short stay after admission to general internal medicine
Characteristic Model A: < 24 h Model B: ≤ 72 h Univariate OR* (95% CI) Multivariable adjusted OR* (95% CI) Univariate OR* (95% CI) Multivariable adjusted OR* (95% CI) Patients Age 0.98 (0.98–0.98) 0.99 (0.99–0.99) 0.98 (0.98–0.98) 0.99 (0.99–0.99) Female sex 1.06 (0.98–1.14) 0.96 (0.90–1.02) 1.05 (1.01–1.10) 0.97 (0.94–1.01) Charlson Comorbidity Index score 0 3.10 (2.79–3.44) 1.97 (1.79–2.16) 2.77 (2.62–2.94) 1.75 (1.66–1.84) 1 1.98 (1.76–2.22) 1.63 (1.47–1.79) 1.91 (1.79–2.03) 1.54 (1.46–1.62) 2 1.33 (1.16–1.52) 1.20 (1.08–1.34) 1.46 (1.36–1.56) 1.29 (1.21–1.36) Not transported via ambulance 2.03 (1.88–2.20) 1.44 (1.34–1.54) 1.92 (1.84–2.00) 1.47 (1.41–1.53) Admitted to general internal medicine at a study site in prior 30 d* 0.54 (0.44–0.65) 0.84 (0.75–0.94) 0.53 (0.48–0.59) 0.77 (0.73–0.82) Laboratory-based Acute Physiology Score 0.96 (0.96–0.97) 0.97 (0.97–0.98) 0.97 (0.97–0.97) 0.98 (0.98–0.98) Physicians Female sex 0.83 (0.77–0.91) 0.80 (0.74–0.86) 0.84 (0.80–0.88) 0.82 (0.79–0.86) Years since graduation 1.00 (1.00–1.01) 1.00 (1.00–1.00) 1.00 (1.00–1.00) 1.00 (1.00–1.00) Situational Admitted weekday 1.34 (1.23–1.47) 1.26 (1.17–1.36) 1.09 (1.03–1.14) 1.05 (1.01–1.10) Admitted evening 2.53 (2.22–2.88) 2.61 (2.33–2.92) 1.20 (1.13–1.28) 1.24 (1.17–1.30) Admitted night 2.93 (2.57–3.33) 2.73 (2.44–3.06) 1.31 (1.23–1.39) 1.29 (1.22–1.37) Admissions to general internal medicine in prior 12 h 1.05 (1.04–1.06) 1.01 (1.00–1.02) 1.02 (1.02–1.03) 1.00 (1.00–1.01) Admitted to short-stay unit 2.26 (2.03–2.52) 1.56 (1.39–1.75) 3.06 (2.83–3.31) 2.35 (2.17–2.54) Fiscal year of admission 1.09 (1.04–1.14) 1.09 (1.05–1.14) 1.05 (1.03–1.08) 1.05 (1.03–1.08) Note: CI = confidence interval, OR = odds ratio.
↵* Derived from logistic regression models with the use of generalized estimating equations to account for clustering of admissions within physicians. The multivariable model included all covariates listed in the table. For variables with more than 2 categories, the reference categories were Charlson Comorbidity Index score 3 (high comorbidity) and admission in the day (v. evening and night).
Diagnosis Duration of stay; no. (%) of admissions* Absolute difference < 24 h > 72 h More common among short stays Nonspecific chest pain 167 (3.9) 194 (0.5) 3.4 Syncope 124 (2.9) 399 (1.0) 1.9 Essential hypertension 90 (2.1) 158 (0.4) 1.7 Intestinal infection 163 (3.8) 822 (2.1) 1.7 Dizziness or vertigo 92 (2.2) 201 (0.5) 1.6 More common among long stays Congestive heart failure 101 (2.4) 2251 (5.9) 3.5 Sepsis 7 (0.2) 1016 (2.6) 2.5 Delirium, dementia, cognitive disorder 62 (0.2) 1444 (3.8) 2.3 Stroke 27 (0.6) 996 (2.6) 2.0 Urinary tract infection 123 (2.9) 1823 (4.8) 1.9 ↵* Calculated among patients discharged alive in less than 24 hours and among those who died in hospital or whose hospital stay exceeded 72 hours. Diagnoses were ranked by the difference in prevalence between short and long stays, and the diagnoses with largest absolute differences between short and long stays are reported.
- Table 4:
Resource use among patients admitted to general internal medicine by duration of stay
Resource Duration of stay; no. (%) of admissions* < 24 h 24–72 h > 72 h Length of time in emergency department, h, mean ± SD 14.8 ± 6.6 15.7 ± 9.0 16.4 ± 9.9 Intravenously administered medication† 2788 (65.7) 10 722 (79.8) 33 022 (86.1) Radiography† 2803 (66.0) 10 013 (74.5) 33 260 (86.7) Computed tomography† 1561 (36.8) 5254 (39.1) 21 772 (56.7) Ultrasonography† 418 (9.8) 2363 (17.6) 12 110 (31.6) Magnetic resonance imaging† 144 (3.4) 842 (6.3) 4983 (13.0) Red blood cell transfusion† 86 (2.0) 593 (4.4) 4522 (11.8) Endoscopy† 92 (2.2) 1053 (7.8) 4037 (10.5) Bronchoscopy† 1 (0.0) 39 (0.3) 965 (2.5) Intensive care unit admission 18 (0.4) 101 (0.8) 2509 (6.5) No advanced interventions‡ 779 (18.4) 1146 (8.5) 1347 (3.5) Note: SD = standard deviation.
↵* Except where noted otherwise.
↵† Number of admissions in which at least 1 of this test or treatment was used.
↵‡ Number of admissions in which none of the following tests or treatments were used: intravenous medication, computed tomography, ultrasonography, magnetic resonance imaging, endoscopy, bronchoscopy or intensive care unit admission.
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