Unnecessary, Avoidable Lengths of Stay: a Strategy for Clinician Empowerment and Effectiveness Evaluation

Hospitalization Clinical Trial

Official title:

Unnecessary, Avoidable Lengths of Stay: a Strategy for Clinician Empowerment and Effectiveness Evaluation

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01422811
• Other study ID #: aopr-rct-los
• Status: Completed
• Phase: Phase 3
• Start date: February 2008
• Est. completion date: February 2010

Study information

• Verified date: July 2018
• Source: Azienda Ospedaliero-Universitaria di Parma
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

1. Background: In recent years an increasing trend in excessive lengths of stay has been recorded at the Parma University Hospital, compared with regional mean values. Excessive lengths of stay have been demonstrated to constitute not just an economic problem, but also a clinical and public health issue. Since the measures taken at our institution so far have not proven effective, the investigators carried out a literature review, which mostly detected observational studies, restricted to the assessment of the impact of a single intervention.

2. Objectives: This project intends to evaluate the effectiveness of a multifaceted strategy aiming to empower clinicians on the issues associated with excessively long and avoidable hospital stays, and enable them to identify corrective measures (according to the principles of clinical governance).

3. Study design: cluster-randomized, parallel group, open-label, community trial

4. Methods: trained personnel will periodically record causes for excessive lengths of stay in all participating wards using an ad hoc data collection sheet. In the wards randomized to the experimental group, interventions aimed to clinician empowerment - provision of reminders and periodical audits - will be implemented.

5. Expected results: A reduction in the experimental vs. the control arm unnecessary lengths of stay is expected, although the introduced measures will also presumably lead to improvement in the wards where they are not implemented.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 3862
• Est. completion date: February 2010
• Est. primary completion date: February 2009
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• patients present on the participating wards during one of 12 randomly selected index days (one for each month of data collection)

Exclusion Criteria:

• patients admitted or discharged on the index days

• patients with length of stay (interview date - admission date) > 90 days

Related Conditions & MeSH terms

• Hospitalization
• Length of Stay

Intervention

Behavioral:
• Multicomponent strategy to reduce avoidable length of stay
The strategy comprises two integrated components: Distribution of two monthly reports, one consisting in the list of patients who, through data collection performed, are classified to be present on the ward although their clinical status is considered compatible with discharge; the other featuring individual length of stay profiles for each physician operating in the intervention arm (information taken from administrative data), allowing comparisons with the rest of the medical staff; Audits performed by professionals of each ward of the intervention arm designed to discuss cases judged to be compatible with discharge. The organization of this work are left to the wards, without any interference from the project team.

Other:
• No intervention
No interventions (reporting, auditing) are planned; nevertheless control ward physicians know study aims and are informed about their patient's data collection.

Locations

Country	Name	City	State
Italy	Azienda Ospedaliero-Universitaria di Parma	Parma

Sponsors (2)

Lead Sponsor	Collaborator
Azienda Ospedaliero-Universitaria di Parma	Regione Emilia-Romagna

Country where clinical trial is conducted

Italy, 

References & Publications (7)

Carey MR, Sheth H, Braithwaite RS. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med. 2005 Feb;20(2):108-15. — View Citation

Lagoe RJ, Westert GP, Kendrick K, Morreale G, Mnich S. Managing hospital length of stay reduction: a multihospital approach. Health Care Manage Rev. 2005 Apr-Jun;30(2):82-92. — View Citation

Meschi T, Fiaccadori E, Cocconi S, Adorni G, Ridolo E, Stefani N, Schianchi T, Novarini A, Spagnoli G, Caminiti C, Pini M, Borghi L. [Analysis of the problem of "difficult hospital discharges" in the University Hospital of Parma]. Ann Ital Med Int. 2004 Apr-Jun;19(2):109-17. Italian. — View Citation

Moro ML. Health care-associated infections. Surg Infect (Larchmt). 2006;7 Suppl 2:S21-3. Review. — View Citation

Selker HP, Beshansky JR, Pauker SG, Kassirer JP. The epidemiology of delays in a teaching hospital. The development and use of a tool that detects unnecessary hospital days. Med Care. 1989 Feb;27(2):112-29. Erratum in: Med Care 1989 Aug;27(8):841. — View Citation

Setrakian JC, Flegel KM, Hutchinson TA, Charest S, Côté L, Edwardes MD, Corbett IB. A physician-centred intervention to shorten hospital stay: a pilot study. CMAJ. 1999 Jun 15;160(12):1735-7. — View Citation

Shojania KG, Wald H, Gross R. Understanding medical error and improving patient safety in the inpatient setting. Med Clin North Am. 2002 Jul;86(4):847-67. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percentage of patient-days compatible with discharge		12 month period [02/2008 - 02/2009] +1 follow up month [02/2010]
Secondary	Overall length of stay (in days)	Overall length of stay = discharge date - admission date	12 month period [02/2008 - 02/2009]

External Links

•   Institution's web site
•   Sponsor funding agency [ita]
•   Study sponsor's website [ita]