Yorke Elisabeth, Huang Lennox, Orkin Julia, Chalk Tyler, Ladha Farrah, Toulany Alene
An adolescent medicine fellow in the Department of Paediatrics, University of Toronto, Ontario.
The chief medical officer and vice president of medical & academic affairs at The Hospital for Sick Children in Toronto, Ontario.
Healthc Q. 2020 Apr;23(1):47-52. doi: 10.12927/hcq.2020.26139.
Length of stay (LOS) is an important issue for many healthcare organizations. In-patients with extreme LOS account for a disproportionately large percentage of hospital costs. Our analysis of over 15,000 pediatric hospital discharges at The Hospital for Sick Children (Toronto, Canada) between 2015 and 2016 revealed that the vast majority of patients with extreme LOS were discharged directly home, with only a minority receiving home-based services. Patients with the greatest LOS were accounted for by primarily four subspecialty services. Although this report outlines an analysis of pediatric in-patients, our findings and implications are relevant for all jurisdictions and populations as many acute care hospitals often "hold" patients with complex, chronic illness as in-patients for extended periods because alternate appropriate services may not exist or be available. Our case study highlights three key areas to improve quality of care for patients with extreme LOS: alternate levels of care, system resources and transitions to home.
住院时长（LOS）对于许多医疗保健机构来说都是一个重要问题。住院时长极长的住院患者在医院成本中所占比例过高。我们对加拿大多伦多病童医院在2015年至2016年间超过15000例儿科出院病例的分析显示，绝大多数住院时长极长的患者直接出院回家，只有少数患者接受居家服务。住院时长最长的患者主要集中在四个亚专科服务领域。尽管本报告概述了对儿科住院患者的分析，但我们的研究结果和启示适用于所有司法管辖区和人群，因为许多急症护理医院常常将患有复杂慢性病的患者作为住院患者长期“收治”，原因可能是不存在或无法提供其他合适的服务。我们的案例研究突出了改善住院时长极长患者护理质量的三个关键领域：替代护理级别、系统资源以及向家庭过渡。
