Department of Public Health Sciences, University of Torino, 10126 Torino, Italy.
Department of Quality and Safety of Care, A.O.U. City of Health and Science of Torino, 10126 Torino, Italy.
Int J Environ Res Public Health. 2020 Dec 18;17(24):9490. doi: 10.3390/ijerph17249490.
Discharge planning is important to prevent surgical site infections, reduce costs, and improve the hospitalization experience. The identification of early variables that can predict a longer-than-expected length of stay or the need for a discharge with additional needs can improve this process. A cohort study was conducted in the largest hospital of Northern Italy, collecting discharge records from January 2017 to January 2020 and pre-admission visits in the last three months. Socio-demographic and clinical data were collected. Linear and logistic regression models were fitted. The main outcomes were the length of stay (LOS) and discharge destination. The main predictors of a longer LOS were the need for additional care at discharge (+10.76 days), hospitalization from the emergency department (ED) (+5.21 days), and age (+0.04 days per year), accounting for clinical variables ( < 0.001 for all variables). Each year of age and hospitalization from the ED were associated with a higher probability of needing additional care at discharge (OR 1.02 and 1.77, respectively, < 0.001). No additional findings came from pre-admission forms. Discharge difficulties seem to be related mainly to age and hospitalization procedures: those factors are probably masking underlying social risk factors that do not show up in patients with planned admissions.
出院计划对于预防手术部位感染、降低成本和改善住院体验非常重要。识别可以预测住院时间延长或需要额外护理才能出院的早期变量，可以改善这一过程。本研究在意大利北部最大的医院进行了一项队列研究，收集了 2017 年 1 月至 2020 年 1 月的出院记录和前三个月的预入院访问记录。收集了社会人口统计学和临床数据。拟合了线性和逻辑回归模型。主要结局是住院时间（LOS）和出院去向。延长 LOS 的主要预测因素是出院时需要额外护理（增加 10.76 天）、从急诊部（ED）住院（增加 5.21 天）和年龄（每年增加 0.04 天），考虑到临床变量（所有变量均 < 0.001）。每年的年龄和 ED 住院与出院时需要额外护理的可能性更高（OR 分别为 1.02 和 1.77，均 < 0.001）。预入院表格中没有发现其他结果。出院困难似乎主要与年龄和住院程序有关：这些因素可能掩盖了在计划入院的患者中没有表现出来的潜在社会风险因素。
