Rogers Cara M, Busch Christopher M, Cuoco Joshua A, Elias Zev, Simonds Gary R
Neurosurgery, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, USA.
Cureus. 2018 Nov 10;10(11):e3567. doi: 10.7759/cureus.3567.
Background The unsustainable cost of healthcare in the United States has made it important for all healthcare professionals to examine their practices for wasteful spending and work to mitigate these costs. When neurosurgical patients remain hospitalized beyond the point of maximum inpatient benefit, this represents a potential source of healthcare economic waste. Objective The objective of this study was to determine the direct and indirect costs to a hospital system when neurosurgical patients remain hospitalized past the maximum inpatient benefit and identify targets to improve this potential wasteful spending. Methods We performed an extensive chart review of all patients admitted to our neurosurgical service from the months of July to October 2016, who had been deemed medically stable for discharge but remained in the hospital past their ideal date of discharge. We analyzed for significant trends in patient factors, procedural acuity, disposition, funding, and other factors that contributed to the delays in discharge. Results A total of 334 patients were admitted to the Carilion Clinic-Virginia Tech Carilion (CC-VTC) inpatient neurosurgery service, and 50 of these admissions (15%) resulted in medically unnecessary prolonged hospitalizations. These patients were hospitalized for a total of 324 days past the dates of ideal discharge. Elective cases had the maximum number of prolonged hospitalizations, while the emergent cases had the maximum number of prolonged hospitalization days. Patients with private insurance had the shortest number of prolonged hospitalization days, and uninsured patients had the longest. Patients requiring disposition to a rehabilitation or a nursing facility remained in the inpatient setting for longer periods than those destined for home. The most common factors limiting appropriate discharge were related to bed availability at outside facilities, funding issues, and differing opinions on appropriate disposition. The medically unnecessary days accounted for 41% of the total hospitalization but accounted for only 12.9% of the billable charges. The billable cost per medically necessary day was $17,326 in comparison to a medically unnecessary day of $2,070. Indirect costs were inferred from these patients utilizing beds and resources that could have been allocated to others with acute needs, given that our hospital is at capacity and on diversion, a significant percentage of the time. Conclusion Neurosurgical patients remaining hospitalized past their maximal inpatient benefit have a significant economic impact on a hospital system. Identifying patients who are at risk for prolonged hospitalizations may provide us with the targets for improvement to mitigate this healthcare economic waste.
背景 美国医疗保健费用难以持续，这使得所有医疗保健专业人员审视其浪费性支出行为并努力降低这些成本变得很重要。当神经外科患者住院时间超过住院最大受益时长时，这就成为医疗经济浪费的一个潜在源头。目的 本研究的目的是确定神经外科患者住院时间超过住院最大受益时长时医院系统所产生的直接和间接成本，并确定改善这种潜在浪费性支出的目标。方法 我们对2016年7月至10月期间入住我院神经外科的所有患者进行了广泛的病历审查，这些患者经判定已达到出院的医学稳定状态，但在理想出院日期后仍住院。我们分析了患者因素、手术急症程度、出院安排、资金及其他导致出院延迟的因素中的显著趋势。结果 共有334名患者入住卡里尼恩诊所-弗吉尼亚理工大学卡里尼恩分校（CC-VTC）住院神经外科，其中50例（15%）导致了不必要的长期住院。这些患者在理想出院日期后共住院324天。择期病例的长期住院数量最多，而急诊病例的长期住院天数最多。有私人保险的患者长期住院天数最短，无保险患者最长。需要转至康复或护理机构的患者在住院环境中停留的时间比那些准备回家的患者更长。限制适当出院的最常见因素与外部机构的床位可用性、资金问题以及关于适当出院安排的不同意见有关。不必要的住院天数占总住院天数的41%，但仅占可计费费用的12.9%。每一个必要住院日的可计费成本为17326美元，相比之下，不必要住院日为2070美元。鉴于我们医院大部分时间已满负荷运转且处于分流状态，从这些占用床位和资源的患者身上推断出间接成本，而这些床位和资源本可分配给其他有紧急需求的患者。结论 神经外科患者住院时间超过其最大住院受益时长会对医院系统产生重大经济影响。识别有长期住院风险的患者可能为我们提供改善目标，以减轻这种医疗经济浪费。
