Mayo N E, Wood-Dauphinee S, Gayton D, Scott S C
Division of Geriatrics, School of Physical and Occupational Therapy, McGill University, Canada.
Stroke. 1997 Mar;28(3):543-9. doi: 10.1161/01.str.28.3.543.
Reducing the amount of nonoptimal time stroke patients spend in the hospital should be a priority because prolonged hospitalization is not only costly but may be detrimental for persons with stroke through deconditioning, social isolation, and the fostering of dependent relationships. The purpose of this study was to determine the amount of time spent by stroke patients in acute-care hospitals that was not justified for medical reasons and to identify mechanisms contributing to nonmedical bed-days.
A retrospective cohort study was performed with 2232 persons admitted for acute stroke to one of 13 hospitals in Montreal, Canada, during 1991. Information was collected on the patient, the stroke, functional status, course in hospital, services, and discharge. Nonmedical bed-days were calculated as the difference between the time to meet specified criteria and time of discharge. Associations with nonmedical bed-days were estimated with adjustment for patient mix.
Acute-care stay averaged 27 days, yielding 60,279 bed-days. Almost 50% of the cohort remained in the hospital after meeting criteria for medical discharge, resulting in 43% of total bed-days not accounted for medically. Fifty percent of persons with delayed discharge did not go home but were discharged to another acute-care hospital or to rehabilitation or long-term care, accounting for 66% of the nonmedical bed-days. Hospital and discharge destination remained strongly associated with nonmedical days, even after adjustment for patient mix.
The single greatest contributor to excessive nonmedical stay appeared to be the need in Quebec for increased access to alternate levels of care, including skilled nursing facilities and rehabilitation centers.
减少中风患者在医院度过的非最佳时间应成为首要任务，因为住院时间延长不仅成本高昂，还可能因身体机能衰退、社会隔离以及依赖关系的形成而对中风患者产生不利影响。本研究的目的是确定中风患者在急症医院度过的无医学理由的时间量，并找出导致非医疗住院日的机制。
对1991年期间在加拿大蒙特利尔13家医院之一因急性中风入院的2232人进行了一项回顾性队列研究。收集了有关患者、中风情况、功能状态、住院过程、服务及出院的信息。非医疗住院日计算为达到特定标准的时间与出院时间之差。通过对患者组合进行调整来估计与非医疗住院日的关联。
急症住院平均时长为27天，产生了60279个住院日。几乎50%的队列在达到医疗出院标准后仍留在医院，导致43%的总住院日无医学依据。50%延迟出院的患者没有回家，而是被转至另一家急症医院、康复机构或长期护理机构，占非医疗住院日的66%。即使对患者组合进行了调整，医院和出院目的地与非医疗住院日仍密切相关。
非医疗住院时间过长的最大单一因素似乎是魁北克需要增加获得包括专业护理机构和康复中心在内的其他护理级别的机会。
