Comparing Hospital Length of Stay Between Persons With LEP and English-Speaking Patients in a Large Rural Academic Medical Center.

BACKGROUND: Patients with limited English proficiency that are hospitalized without regular access to professional medical interpreters have a longer length of stay (LOS). 1 The authors studied the difference in LOS between English-speaking patients and patients with limited English proficiency in New Hampshire's only academic trauma medical center. The authors also examined race, ethnicity, and distance of residence from hospital. METHODS: Retrospective data were queried from EPIC, the electronic medical record system used by the authors. Queried data focused on inpatient hospitalizations between January 1, 2019, and December 31, 2021. Patient primary language was grouped into English, Spanish, and other non-English language. RESULTS: Spanish-speaking patients live on average 39.6 miles farther from a hospital than English-speaking patients and have a 0.34 lower case mix index. After English, Spanish is the second-most frequently spoken language. Regression analyses found language to be a significant factor in LOS, LOS variance, and case mix index. DISCUSSION: A 2.34-day longer LOS for Spanish-speaking patients demonstrates an important health care disparity warranting further attention.

Nurse-Driven Interprofessional Rounds: Improving Care Coordination and Length of Stay.

BACKGROUND: Inpatient oncology units care for patients with some of the most complex medical conditions outside of the intensive care unit. These patients benefit from structured care coordination. Reduced ability to admit patients to oncology beds contributes to delays in specialty care. OBJECTIVES: This quality improvement initiative established nurse-driven interprofessional rounds (IPRs) to reduce length of stay (LOS), improve discharge time of day, and enhance care coordination, patient flow, and access to care in the community. METHODS: Care coordination during enhanced IPRs (eIPRs) included estimation of discharge dates, comparison of LOS to a standard geometric mean LOS, and discussion of clinical milestones and barriers to progression and discharge. Data analysis evaluated the effect of eIPRs on key outcomes. FINDINGS: Although LOS variance was reduced by 15.8% and 44.1% in all-unit and hematology-oncology discharges, respectively, the results were not significant. Discharges by 2 pm improved significantly for all-unit and hematology-oncology populations, respectively. Patient flow measured by accepted patient transfers requesting hematology-oncology services improved significantly.

Opioid Dependence and Overdose After Surgery: Rate, Risk Factors, and Reasons.

OBJECTIVE: To determine: (1) incidence of " opioid never events " ( ONEs ), defined as the development of opioid dependence or overdose in an opioid-naive surgical patient who is prescribed opioids postoperatively and (2) risk factors predicting ONEs. BACKGROUND: Patients receiving opioids after surgery are at risk of experiencing life-threatening opioid-related adverse events. METHODS: An electronic medical record review identified surgical patients at an academic medical center between January 1, 2015, and December 31, 2018, followed through March 31, 2020. ONEs were determined by International Classification of Diseases, Ninth/10th Revision (ICD-9/10) codes, and electronic medical record review. RESULTS: A total of 35,335 opioid-naive surgical patients received a perioperative opioid prescription. The median follow-up was 3.47 years (range: 1.25-5.25 years). ONEs occurred in 0.19% (67/35,335) of patients. The ONE rate was 5.6 per 10,000 person-years of follow-up. Ten of 67 ONE patients overdosed on opioids. The median time to ONE was 1.6 years; the highest ONE rate was observed 1 to 2 years after surgery. In multivariate analysis, patients receiving opioid prescriptions 90 to 180 or 90 to 360 days after surgery had the highest risk of developing ONEs [hazard ratio (HR)=6.39, confidence interval (CI): 3.72-10.973; HR=6.87, CI: 4.24-11.12, respectively]. Surgical specialty (HR=5.21, 2.65-0.23) and patient age (HR=4.17, CI: 2.50-6.96) were also risk factors for ONEs. Persistent opioid use 90 to 360 days after surgery was present in 45% of patients developing ONEs. CONCLUSIONS: Postoperative opioid dependence or overdose is a significant health problem, affecting roughly 2 per 1000 opioid-naive surgical patients prescribed an opioid and followed for 5 years. Risk factors for the development of ONEs include opioid use 3 to 12 months after surgery, patient age, and surgical procedure.

Utilization of an Outpatient Integrated Infusion Suite to Decrease Length of Stay, Increase Revenue, and Improve Patient Experience for Elective Chemotherapy Admissions.

PURPOSE: Reduction of chemotherapy start times (CST) and length of stay (LOS) for elective chemotherapy admissions is a priority. The aim of this project was to improve efficiency of patient care while simultaneously increasing revenue by reducing LOS and transitioning high-cost chemotherapy to the outpatient setting. METHODS: A multidisciplinary quality improvement team proposed building a new outpatient infusion suite in close proximity to the inpatient unit. This suite was then integrated into the flow of elective inpatient chemotherapy admissions and discharges for etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R). Quality measures such as CST, LOS, and revenue were used to evaluate the new infusion suite. RESULTS: In the pilot phase of the study, the average CST improved by approximately 1 hour 45 minutes (P = .0218). The mean LOS was reduced from 4.3 to 4.1 midnights (P = .0214). In terms of hours, LOS was reduced from 105.8 to 95.5 hours (P < .0001). A mean quarterly revenue of $309,410 US dollars was noted during the pilot that had not been previously billed. These improvements were sustained throughout the control phase. CONCLUSION: Delays in CST and prolonged LOS lead to patient dissatisfaction and increased cost to the health care system. Focus groups and patient feedback are important when designing and implementing new workflows. The creation of an outpatient integrated infusion suite allows medical centers to meet patients' expectations of reducing number of visits while also reducing LOS and capturing new revenue. Adherence to scheduling guidelines further reduces the CST for elective chemotherapy administration.