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Interventions To Decrease Hospital Length of Stay

Research Protocol Aug 24, 2020

Interventions to Decrease Hospital Length of Stay

I. Background and Objectives for the Technical Brief

In 2014, there were 35.4 million inpatient infirmary stays in the U.S.: 3.ix million neonatal; 4.one million maternity-related admissions; 7 meg surgical; and 17 million medical.i Unnecessary days in the infirmary may lead to patient complications (e.chiliad., healthcare-associated infections, falls) and increased costs. In add-on, length of hospitalization may affect negatively both patient and staff feel.2 Delays in infirmary belch may be related to unnecessary waiting, poor organization of care, delays in controlling, or difficulties related to discharge planning.ii,three

A broad array of interventions take been adult to reduce length of stay (LOS), and they differ in design, intent, and focal point. While some interventions primarily aim at improving clinical intendance (ERAS,4-6 clinical pathways,seven and early patient mobility programseight) other approaches address logistical factors (care coordination, transition and discharge planning,9-11 case management,12 medication management,13 or specialized units for high-take a chance populations14,fifteen). Other interventions target the workforce, such as multidisciplinary care teams16 or redesigned staffing models.17

Interventions accept the potential to create trade-offs between outcomes. Reducing LOS might increase concerns for risk of readmission or shifting costs of care.2 Conversely, interventions might exist ineffective in reducing LOS, but yield pregnant improvements in other patient-centered outcomes, such as patient satisfaction. Farther, handling for exacerbation of a complex chronic condition may differently prioritize interventions to reduce LOS, compared with handling of an acute illness or a surgical process.

Detail patient populations, such equally patients who are socially or economically vulnerable or with medically-complex needs, may be at increased risk for unnecessary delays in discharge.18-20 These patients are typically at greater chance for agin events during and after hospitalization.21 Interventions that focus on addressing the challenging LOS reduction needs of these populations might increase the efficiency of patient throughput while improving the delivery of safe and constructive care.

Successful hospital-based interventions may significantly depend on ecology factors including the unique resources, personnel, leadership, and infrastructure specific to each setting. A hospital or health system-based approach could therefore address the multiple factors contributing to unnecessary delays in infirmary discharge.2 The goals of this Technical Brief (TB) are to: (i) categorize and evaluate current cognition regarding the multitude of strategies to reduce LOS; (ii) examine contextual factors (eastward.chiliad., resources, costs, staffing, and engineering science) that bear upon implementation of interventions; (3) identify emerging concepts or initiatives that may merit futurity research; and (4) develop a series of bear witness maps to inform health systems' strategic efforts.

Two. Guiding Questions

GQ 1: What are the characteristics of interventions to subtract length of hospital stay and how do they vary?

GQ 2: What are the contextual factors (e.g., resources, staffing, engineering science) that bear on implementation of interventions to decrease infirmary length of stay?

GQ 3: What is the current evidence addressing interventions to decrease infirmary length of stay?

GQ four: What hereafter research is needed to close evidence gaps regarding interventions to decrease length of hospital stay?

Three. Methods

1. Data Collection

A. Discussions with Key Informants

Nosotros will interview half-dozen–ix Key Informants (KIs) with expertise in 1 or more than of the following areas: health system leadership, healthcare quality comeback and patient condom, regulation, social determinants of wellness, payment and delivery organization transformation, and chronic conditions associated with long LOS. KIs will exist queried on cardinal priority areas for wellness systems, characteristics of medically circuitous patients and vulnerable populations, interventions specific and/or different to reducing LOS in these at risk populations, and outcomes important to a system, care team, and/or patients. They will also be asked to place important characteristics to support assessments about feasibility of implementation and the challenges encountered. Patient advocates will also be recruited as KIs, to ensure that the patient perspective is represented.

KI input will assist inform GQ 1, 2, and four. KI input will also be used to refine the systematic literature search, identify grey literature resource, provide data virtually ongoing research, confirm evidence limitations, recommend approaches to help fill these gaps, and provide input on the potential design, focus, and audience for the evidence maps that will be featured in this TB. Table 1 presents potential questions that KIs will be asked.

Table 1. Potential KI Questions

  1. What clinical conditions are meridian priorities for you lot when thinking virtually efforts to reduce LOS? How exercise you decide on prioritization for these efforts?
  2. Based on national admissions and LOS data, some of the chronic conditions for specific focus include: acute exacerbations of chronic COPD, acute exacerbations of chronic CHF.
    1. Are at that place other chronic conditions with frequent decompensations ofttimes requiring inpatient admission missing from this list that are of item interest?
  3. Can y'all describe characteristics of medically circuitous patients for which interventions to reduce LOS would be particularly helpful?
  4. How would you describe vulnerable populations within a hospital setting as information technology relates to LOS?
    1. Are there interventions of involvement that would be specific and/or different to LOS in these at risk populations?
  5. How would you lot define a infirmary or wellness system-based organizational intervention to reduce LOS? What are the most important elements of such interventions?
  6. What characteristics of interventions are important for you to know or sympathise so that you can judge feasibility of implementation? (e.one thousand. staffing requirements, infrastructure, resource utilization)
  7. How do emerging or existing payment models affect approaches to operationalizing or prioritizing LOS interventions? The data almost interventions we glean from studies will exist presented in evidence maps. For example, this table on the National Library of Medicine website.
    1. What are your thoughts most 2 or 3 key variables that would be most helpful for you lot to see graphically presented?
    2. What types of categories of interventions or conditions would be useful to highlight or grouping together?
  8. What outcomes other than LOS, including potential positive or negative furnishings to a organization or care team are of detail interest for interventions to subtract LOS? What outcomes are of import to patients?
  9. Where do y'all think are the virtually of import gaps in current knowledge, and can y'all recommend approaches to assist fill and/or identify these gaps?
  10. In addition to published literature, what unpublished resources could help inform our analysis?

B. Gray Literature Search

Gray literature sources and retrieval will include websites of relevant stakeholder organizations (e.g., American Hospital Clan, Institute for Healthcare Improvement, The Joint Commission), healthcare consulting firms (east.g., Premier, Vizient, Socially Determined), and authorities agencies (e.1000., ClinicalTrials.gov, the Agency for Healthcare Inquiry and Quality [AHRQ], The Centers for Medicare and Medicaid [CMS]). Besides, we will search for evidence in non-medical resource that often address healthcare management, such equally Modernistic Healthcare and Harvard Business Review. Input from the KIs will be used to place other grey literature sources.

C. Published Literature Search

Published literature volition be used to reply GQ 3. Literature searches will be performed past Medical Librarians within the Evidence-based Practice Center (EPC) Information Center, and will follow established systematic review protocols. We will search the following databases using controlled vocabulary and text words: MEDLINE, PubMed (unprocessed records just), EMBASE, CINAHL, and the Cochrane Library to place systematic reviews (SRs) with and without meta-assay. Searches will encompass the literature published since January 1, 2010. Search dates may exist adjusted based on the quantity and quality of the bachelor literature. Appendix 1 presents a sample search strategy.

Literature screening will be performed in duplicate using the database Distiller SR (Evidence Partners, Ottawa, Canada). Literature search results volition initially be screened for relevancy. Selected abstracts will be screened in duplicate. Studies that appear to fit the scope of the brief will exist retrieved in full and screened again in duplicate. All disagreements will exist resolved by consensus give-and-take amidst the two original screeners. The literature searches volition exist updated during the Peer Review process, earlier finalization of the review.

D. Inclusion of Published Literature

This TB will focus on evaluating existing English-language systematic reviews (SRs) of published studies. SRs will be included if they run across the inclusion criteria listed in Table 2. Nosotros volition consider SRs of both randomized and non-randomized main studies. We will limit inclusion of SRs to those meeting sure methodological standards, such as providing search criteria, explicit inclusion/exclusion criteria, and hazard-of-bias assessment. Where bachelor, we volition abstruse and use forcefulness of evidence (SOE) ratings provided by SRs; including the methods used to assess SOE; if not provided, we will use AHRQ EPC guidance to assess SOE. We will note if the SRs' conclusions for a given intervention had different SOE ratings. We will supplement our searches with the results of exploratory searches for randomized controlled trials (RCTs) on topics non covered in the SRs in society to assess the need for future SRs or primary studies. We will use the same inclusion and exclusion criteria to the results of the exploratory search for RCTs.

Nosotros will exclude SRs focused on patients undergoing non-emergent constituent procedures or focused solely on intensive care units, emergency department visits, observation units, or specialty hospitals. We will likewise exclude SRs of interventions initiated, managed, or implemented by entities external to the hospital setting, such as community organizations. Interventions non intended or expected to reduce LOS volition not be evaluated. SRs will besides be excluded if they only describe cost-related outcomes without reporting LOS. Finally, we will exclude SRs of primary studies that were conducted solely outside the United States.

Table 2. Inclusion and Exclusion Criteria

Category Criteria
Population

Include hospitalized children and adults (including pregnant women) with i or more than of the post-obit risk factors for prolonged LOS, harms, or agin outcomes:

Vulnerable populations:

  • high levels of socioeconomic risk (eastward.grand., housing instability, social isolation, social vulnerability, social mobility, lack of social network, lack of social support, limited access to healthcare services or social services, rural settings)
  • medically uninsured, underinsured
  • hospitalization at safe-net, tertiary, or quaternary care institution
  • limited English proficiency

Medically complex patients:

  • comorbid psychiatric or behavioral wellness atmospheric condition
  • comorbid substance employ disorder
  • frailty
  • multimorbidity (≥ii chronic health weather)
  • high volume chronic affliction weather condition with pregnant hazard of exacerbation or complications, including chronic kidney disease, diabetes, congestive centre failure, and chronic obstructive pulmonary disease
Exclude patients undergoing non-emergent constituent procedures
Interventions

Include interventions that are:

  • initiated within the hospital; and
  • designed (at least in role) to evaluate LOS

Examples include just are not limited to: clinical pathways, ERAS, discharge planning, example management, multidisciplinary teams

Exclude interventions that are:

  • initiated, managed, or implemented by entities wholly external to the hospital setting; or
  • are non intended or expected to reduce LOS

Examples include but are not limited to ambulatory clinic follow-up visits, community-based back up resource, regulatory policies, third-party reimbursement programs
Comparators Include: Usual care; whatever comparing; other active intervention
Outcomes

Include

Primary:

  • Length of stay, length of stay index

Secondary:

  • Readmission
  • Patient harms, such as infirmary-acquired conditions and medical errors
  • Patient feel/satisfaction
  • Patient functional render
  • Clinician/staff satisfaction
  • Resource use including patient flow and discharge disposition

Exclude studies that only describe toll-related outcomes without reporting LOS, exclude cost related outcomes that practice not quantify valuations of both comparisons or alternative interventions (including usual or standard of care) and both of their associated outcomes
Timing Include: All
Setting

Include

  • acute care hospitalizations in general or pediatric hospitals
  • reviews of studies conducted in the U.s.

Exclude

  • reviews focused solely on ICU stays, emergency departments, or observation units
  • specialty hospitals (e.one thousand., psychiatric, ophthalmologic, orthopedic, cancer, rehabilitation, long-term astute care)
  • reviews of studies conducted solely outside the U.South.

2. Information System and Presentation:

A. Information Management

Descriptive characteristics will exist abstracted from published SRs and tabled. Factors to be abstracted volition include:

  • Patient population (age; sex activity; primary linguistic communication; main diagnosis and comorbidities; medical insurance or lack of coverage; housing type; other measures of social isolation and/or vulnerability every bit reported past SRs)
  • Hospital characteristics (developed/pediatric; bed size; location [urban, rural, etc.]; blazon of infirmary [academic medical heart, community hospital]; wellness organization affiliation or standalone hospital)
  • Intervention characteristics (description of intervention; resources needed; implementation factors including durability, if described)
  • Comparators (description of comparison grouping, including models of care for controlled trials or cohort studies, or preexisting infirmary care factors for pre-post studies)
  • Outcomes (LOS or LOS index; sustainment of LOS changes; readmission rates; measures of hospital-related harms equally reported in SRs; patient functional status and time to functional return; patient satisfaction/feel; clinician/staff feel; resource use; patient throughput)

B. Data Presentation

Data that are abstracted will exist presented in searchable testify tables. To optimize usability of the findings we volition design a series of visual testify maps that broadly summarize the book and quality of existing research for each intervention category, and depict their effects on LOS. Nosotros will also highlight the current state of cognition regarding implementation of interventions and important evidence gaps (e.g., qualitatively summarize relevant results from the exploratory searches for randomized controlled trials) that crave further study and assessment using data visualization approaches equally appropriate. Finally, significant perspectives and insights gathered from the KIs volition be summarized narratively.

IV. References

  1. McDermott KW, Elixhauser A, Sun R. Trends in hospital inpatient stays in the U.s.a., 2005-2014. HCUP Statistical Cursory #225. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2017 Jun.
  2. Rojas-García A, Turner S, Pizzo E, et al. Impact and experiences of delayed discharge: a mixed-studies systematic review. Health Wait. 2018 Feb;21(one):41-56. DOI: x.1111/hex.12619. PMID: 28898930.
  3. Ragavan MV, Svec D, Shieh L. Barriers to timely discharge from the general medicine service at an bookish pedagogy hospital. Postgrad Med J. 2017 Sep;93(1103):528-33. DOI: 10.1136/postgradmedj-2016-134529. PMID: 28450581.
  4. Greer NL, Gunnar WP, Dahm P, et al. Enhanced recovery protocols for adults undergoing colorectal surgery: a systematic review and meta-assay. Dis Colon Rectum. 2018 Sep;61(9):1108-18. Besides available: DOI: 10.1097/DCR.0000000000001160. PMID: 30086061.
  5. Lee Y, Yu J, Doumouras AG, et al. Enhanced Recovery Later on Surgery (ERAS) versus standard recovery for elective gastric cancer surgery: a meta-analysis of randomized controlled trials. Surg Oncol. 2019 Nov 25;32:75-87. DOI: ten.1016/j.suronc.2019.xi.004. PMID: 31786352.
  6. Dietz N, Sharma K, Adams Due south, et al. Enhanced Recovery After Surgery (ERAS) for spine surgery: a systematic review. World Neurosurg. 2019 October;130:415-26. DOI: 10.1016/j.wneu.2019.06.181. PMID: 31276851.
  7. Rotter T, Kinsman Fifty, James E, et al. Clinical pathways: furnishings on professional practise, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010;(3):CD006632. PMID: 20238347.
  8. Hoyer EH, Friedman M, Lavezza A, et al. Promoting mobility and reducing length of stay in hospitalized general medicine patients: a quality-improvement projection. J Hosp Med. 2016 May;11(five):341-vii. DOI: 10.1002/jhm.2546. PMID: 26849277.
  9. Ridwan ES, Hadi H, Wu YL, et al. Furnishings of transitional care on hospital readmission and bloodshed rate in subjects with COPD: a systematic review and meta-analysis. Respir Care. 2019 Sep;64(9):1146-56. DOI: 10.4187/respcare.06959. PMID: 31467155.
  10. Van Spall HG, Rahman T, Mytton O, et al. Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail. 2017 November;nineteen(xi):1427-43. DOI: 10.1002/ejhf.765. PMID: 28233442.
  11. Zhu QM, Liu J, Hu HY, et al. Effectiveness of nurse-led early on discharge planning programmes for infirmary inpatients with chronic affliction or rehabilitation needs: a systematic review and meta-analysis. J Clin Nurs. 2015 Oct;24(xix-xx):2993-3005. DOI: 10.1111/jocn.12895. PMID: 26095175.
  12. Grover CA, Sughair J, Stoopes S, et al. Example management reduces length of stay, charges, and testing in emergency section frequent users. W J Emerg Med. 2018 Mar;19(2):238-44. DOI: 10.5811/westjem.2017.ix.34710. PMID: 29560049.
  13. Okere AN, Renier CM, Frye A. Predictors of hospital length of stay and readmissions in ischemic stroke patients and the bear upon of inpatient medication direction. J Stroke Cerebrovasc Dis. 2016 Aug;25(viii):1939-51. DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.011. PMID: 27199200.
  14. Mabire C, Dwyer A, Garnier A, et al. Effectiveness of nursing discharge planning interventions on health-related outcomes in discharged elderly inpatients: a systematic review. JBI Database Syst Rev Implement Rep. 2016 Sep;fourteen(ix):217-threescore. DOI: 10.11124/JBISRIR-2016-003085. PMID: 27755325.
  15. Segers East, Ockhuijsen H, Baarendse P, et al. The impact of family centred care interventions in a neonatal or paediatric intensive care unit on parents' satisfaction and length of stay: a systematic review. Intensive Crit Care Nurs. 2019 Feb;50:63-70. DOI: 10.1016/j.iccn.2018.08.008. PMID: 30249426.
  16. Mercedes A, Fairman P, Hogan L, et al. Effectiveness of structured multidisciplinary rounding in acute care units on length of stay and satisfaction of patients and staff: a quantitative systematic review. JBI Database Syst Rev Implement Rep. 2016 Jul;14(7):131-68. DOI: x.11124/JBISRIR-2016-003014. PMID: 27532795.
  17. Butler Thousand, Schultz TJ, Halligan P, et al. Hospital nurse-staffing models and patient-and staff-related outcomes. Cochrane Database Syst Rev. 2019 Apr 23;(four):CD007019. DOI: 10.1002/14651858.CD007019.pub3. PMID: 31012954.
  18. Gruneir A, Bronskill SE, Maxwell CJ, et al. The association between multimorbidity and hospitalization is modified by individual demographics and physician continuity of care: a retrospective cohort study. BMC Health Serv Res. 2016 Apr 27;16:154. DOI: 10.1186/s12913-016-1415-5. PMID: 27122051.
  19. Moore 50, Cisse B, Batomen Kuimi BL, et al. Impact of socio-economic status on hospital length of stay following injury: a multicenter cohort report. BMC Health Serv Res. 2015 Jul 25;15:285. DOI: 10.1186/s12913-015-0949-two. PMID: 26204932.
  20. Wadhera RK, Choi E, Shen C, et al. Trends, causes, and outcomes of hospitalizations for homeless individuals: a retrospective cohort study. Med Care. 2019 January;57(1):21-7. DOI: 10.1097/MLR.0000000000001015. PMID: 30461584.
  21. Naessens JM, Campbell CR, Shah N, et al. Outcome of affliction severity and comorbidity on patient safety and agin events. Am J Med Qual. 2012 January-Feb;27(1):48-57. DOI: 10.1177/1062860611413456. PMID: 22031176.

Five. Summary of Protocol Amendments

In the event of protocol amendments, the date of each amendment will be accompanied past a description of the change and the rationale.

Six. Cardinal Informants

Within the Technical Brief process, Fundamental Informants serve as a resources to offer insight into the clinical context of the engineering/intervention, how it works, how it is currently used or might be used, and which features may exist important from a patient of policy standpoint. They may include clinical experts, patients, manufacturers, researchers, payers, or other perspectives, depending on the technology/intervention in question. Differing viewpoints are expected, and all statements are crosschecked against bachelor literature and statements from other Key Informants. Information gained from Key Informant interviews is identified as such in the written report. Key Informants practise not do assay of any kind nor contribute to the writing of the report and will non review the report, except as given the opportunity to practice so through the public review mechanism.

Key Informants must disclose any financial conflicts of involvement greater than $5,000 and whatsoever other relevant business or professional conflicts of involvement. Because of their unique clinical or content expertise, individuals are invited to serve as Key Informants and those who nowadays with potential conflicts may be retained. The Besides and the EPC piece of work to balance, manage, or mitigate whatever potential conflicts of interest identified.

VII. Peer Reviewers

Peer reviewers are invited to provide written comments on the typhoon study based on their clinical, content, or methodologic expertise. Peer review comments on the draft report are considered past the EPC in preparation of the final report. Peer reviewers do not participate in writing or editing of the final report or other products. The synthesis of the scientific literature presented in the last report does not necessarily represent the views of individual reviewers. The dispositions of the peer review comments are documented and may exist published iii months after the publication of the evidence study.

Potential Reviewers must disclose any financial conflicts of involvement greater than $five,000 and whatever other relevant business or professional person conflicts of interest. Invited Peer Reviewers may not accept any fiscal conflict of interest greater than $5,000. Peer reviewers who disclose potential concern or professional person conflicts of interest may submit comments on draft reports through the public comment mechanism.

VIII. EPC Team Disclosures

EPC core team members must disclose any fiscal conflicts of involvement greater than $1,000 and any other relevant business organization or professional conflicts of interest. Related fiscal conflicts of interest that cumulatively total greater than $1,000 volition unremarkably disqualify EPC core team investigators.

Ix. Part of the Funder

This projection is funded under Contract No. 75Q80120D00002 from the Bureau for Healthcare Research and Quality, U.S. Department of Health and Human Services. The AHRQ Chore Guild Officer will review contract deliverables for adherence to contract requirements and quality. The authors of this study are responsible for its content. Statements in the report should non be construed as endorsement by the Agency for Healthcare Enquiry and Quality or the U.Southward. Department of Wellness and Human Services.

Appendix one. Sample Search Strategy

Set up Number

Concept

Search statement

i

Length of Stay –

'length of stay'/exp OR ('hospital belch'/exp AND 'time gene'/exp

2

Length of Stay – keywords in title, abstruse

("LOS" OR (length NEXT/three stay) OR "bed days" OR (length NEAR/3 hospital*) OR ((inpatient OR patient OR short) NEAR/1 (stay* OR throughput OR flow*)) OR ((Discharge* OR stay) NEAR/4 (delay* OR timely OR timeliness OR fast OR faster OR sooner OR quick* OR haste* OR rapid* OR early on OR earlier OR reduc* OR decrease OR lessen)) OR (fast NEXT/ane track)):ti,ab

3

Combine sets: LOS

#ane OR #2

4

Vulnerable populations – social – controlled terms

'vulnerable population'/exp OR 'frail elderly'/exp OR 'homelessness'/exp OR 'homeless person'/exp OR 'poverty'/exp OR 'sexual and gender minority'/exp OR 'minority group'/exp OR 'household economical status'/exp OR 'lowest income grouping'/exp OR 'social status'/exp OR 'wellness disparity'/exp OR 'health equity'/exp OR 'income group'/exp OR 'safe net hospital'/exp OR 'medically uninsured'/exp OR 'health literacy'/exp OR 'educational status'/exp OR 'literacy'/exp OR 'employment'/exp OR 'employment status'/exp OR 'veteran'/exp OR 'veterans health'/exp OR 'migrant'/exp OR 'English as a second language'/exp OR 'limited English proficiency'/exp OR 'language ability'/exp OR 'prisoner'/exp OR 'social environment'/exp OR 'wellness care access'/exp OR 'socioeconomics'/de OR 'social isolation'/exp

5

Vulnerable populations – social – keywords in title, abstruse

(((vulnerable OR marginalized) About/two (population* OR patient* OR person*)):ti,ab) OR homeless*:ti,ab OR poverty*:ti,ab OR ((poor NEAR/3 (people OR persons)):ti,ab) OR 'low income':ti,ab OR (((sexual OR gender OR indigenous OR racial) NEAR/3 minorit*):ti,ab) OR socioeconomic*:ti,ab OR ((social NEAR/ii (course* OR wellness* OR status OR back up OR mobility OR isolation)):ti,ab) OR ((wellness* NEAR/4 (disparit* OR equit* OR inequalit* OR literacy OR illiteracy OR literate OR illiterate* OR inequit* OR admission*)):ti,ab) OR ((('safety net' OR 'safe-cyberspace') NEAR/3 (provider* OR infirmary*)):ti,ab) OR uninsured:ti,ab OR 'un insured':ti,ab OR 'under insured':ti,ab OR 'under-insured':ti,ab OR underinsured:ti,ab OR ((without NEXT/3 insurance):ti,ab) OR unemploy*:ti,ab OR underemploy*:ti,ab OR 'working poor':ti,ab OR veteran*:ti,ab OR immigrant*:ti,ab OR migrant*:ti,ab OR refugee*:ti,ab OR ((english NEAR/3 (proficien* OR second)):ti,ab) OR (((linguistic communication OR communication) NEAR/three bulwark*):ti,ab) OR prison*:ti,ab OR incarcerat*:ti,ab OR jail*:ti,ab

6

Combine sets: vulnerable populations - social

#four OR #v

7

Vulnerable populations – diseases/conditions –controlled terms

'disabled person'/exp OR 'inability'/exp OR 'developmental disorder'/exp OR 'mental affliction'/exp OR 'communication barrier'/exp OR 'drug dependence'/exp OR 'multiple chronic atmospheric condition'/exp OR 'rare affliction'/exp OR 'chronic disease'/exp OR 'substance use'/de OR 'alcohol consumption'/exp OR 'cannabis utilize'/exp OR 'habit'/de OR 'chronic obstructive lung disease'/exp OR 'heart failure'/exp OR 'dementia'/exp OR 'diabetes mellitus'/exp OR 'chronic kidney failure'/exp OR cormobidity/exp/mj

viii

Vulnerable populations – diseases/conditions –keywords

frail:ti,ab OR frailty:ti,ab OR disabilities:ti,ab OR disabled:ti,ab OR multimorbid*:ti,ab OR ((multi Side by side/1 morbid*):ti,ab) OR alcoholic*:ti,ab OR (((alcohol OR substance* OR drug OR drugs OR opiate* OR opioid* OR narcotic*) Most/3 (abuse OR misuse OR addict* OR disorder* OR users)):ti,ab) OR (((rare OR chronic) Most/2 (affliction* OR disorder*)):ti,ab) OR ((chronic* Nigh/2 (multisymptom OR 'multi symptom')):ti,ab) OR ((multiple Well-nigh/three (comorbid* OR morbid*)):ti,ab) OR (((mental OR developmental OR behavioral) NEAR/3 (disease* OR disorder* OR delay*)):ti,ab) OR ((chronic Adjacent/one obstruct* Next/two (lung* OR pulmonary*)):ti,ab) OR copd*:ti,ab OR (((heart OR cardio* OR cardiac OR cardiogen*) NEAR/2 (failure OR stupor OR death OR infarc* OR arrest*)):ti,ab) OR dementia*:ti,ab OR alzheimer*:ti,ab OR diabetes:ti,ab OR diabetic:ti,ab OR chronic:ti,ab OR (('end phase' NEAR/3 kidney):ti,ab) OR renal:ti,ab OR esrd:ti,ab OR ckd:ti,ab OR (circuitous* NEAR/ii patient*)

9

Combine sets – vulnerable populations – disease/atmospheric condition -

#7 OR #viii

ten

Combine sets – all vulnerable populations

#6 OR #ix

12

Combine sets – LOS plus population

#3 AND #10

13

Remove unwanted study types

#12 Non (abstruse:nc OR almanac:nc OR volume/de OR 'case study'/de OR 'case study'/de OR conference:nc OR 'conference abstract':it OR 'conference paper'/de OR 'conference newspaper':it OR 'briefing proceeding':pt OR 'conference review':it OR congress:nc OR editorial/de OR editorial:it OR erratum/de OR letter of the alphabet:information technology OR notation/de OR notation:it OR coming together:nc OR sessions:nc OR 'short survey'/de OR symposium:nc)

14

Limit to SRs/MAs

#13 AND ('systematic review'/de OR 'meta analysis'/de OR (systematic* NEAR/ii review*) OR metaanalysis OR 'meta analysis' OR Cochrane)

15

Limit

Limit to English language, human, py:2010-2020

Broad search for Length of Stay – no PICO limits applied

sixteen

LOS – major concepts, title words

'length of stay'/exp/mj OR ('infirmary discharge'/exp/mj AND 'time factor'/exp/mj) OR 'los':ti OR ((length Next/3 stay):ti) OR 'bed days':ti OR ((length NEAR/3 hospital*):ti) OR (((inpatient OR patient OR short) NEAR/ane (stay* OR throughput OR flow*)):ti) OR (((belch* OR stay) Virtually/four (delay* OR timely OR timeliness OR fast OR faster OR sooner OR quick* OR haste* OR rapid* OR early OR earlier OR reduc* OR subtract OR lessen)):ti) OR ((fast Side by side/i rails):ti)

17

Remove unwanted publication types

#16 Not (abstract:nc OR annual:nc OR book/de OR 'example report'/de OR 'case written report'/de OR conference:nc OR 'briefing abstract':it OR 'conference paper'/de OR 'briefing paper':it OR 'briefing proceeding':pt OR 'conference review':information technology OR congress:nc OR editorial/de OR editorial:it OR erratum/de OR alphabetic character:it OR annotation/de OR note:it OR coming together:nc OR sessions:nc OR 'short survey'/de OR symposium:nc)

eighteen

Limit to SRs/MAs

#17 AND ('systematic review'/de OR 'meta assay'/de OR (systematic* NEAR/2 review*) OR metaanalysis OR 'meta analysis' OR Cochrane)

19

Limit to English language, PY

Limit #18 to English, human being, py:2010-2020

twenty

LOS – major concept, title, abstract

'length of stay'/exp/mj OR 'los':ti,ab OR ((length Side by side/three stay):ti,ab) OR 'bed days':ti,ab OR ((length Nearly/3 hospital*):ti,ab)

21

Organizational interventions – controlled terms

'health program'/exp/mj OR 'care coordination'/exp/mj OR 'instance management'/exp/mj OR 'interdisciplinary communication'/exp/mj OR 'hospital policy'/exp/mj OR 'clinical decision making'/exp/mj OR 'hospital readmission reduction program'/exp/mj OR 'clinical pathway'/exp/mj OR 'personnel management'/exp/mj OR 'hospital personnel'/exp/mj OR 'care bundle'/exp/mj OR 'wellness care quality'/exp/mj OR 'multidisciplinary team'/exp/mj OR 'patient care'/exp/mj

22

Organizational interventions - keywords

"instance management":ti,ab OR ((interdisciplin* OR multdisciplin*) Nearly/3 (rounds OR rounding OR communicat*)):ti,ab OR ((organization* OR hospital*) NEAR/five (policy OR policies OR program* OR intervention*)):ti,ab OR (staff OR staffing OR bundl* OR model* OR pathway*):ti,ab OR ("system level" OR "hospital wide"):ti,ab

23

Specific organizational interventions

('lean process' OR 'eras' OR ((enhanced NEXT/1 recovery):ti,ab) OR 'infirmary elder life plan' OR 'goal-directed accomplishment through geographic location' OR gagl OR 'older people assessment liason' OR opal OR 'early supported discharge' OR 'early dwelling house supported discharge'):ti,ab OR (six NEXT/i sigma):ti,ab OR (OASIS Side by side/four framework*):ti,ab

24

Combine sets – LOS organizational interventions

#xx AND (#21 OR #22 OR #23)

25

Remove unwanted publication types

#24 NOT (abstract:nc OR annual:nc OR book/de OR 'case written report'/de OR 'case study'/de OR conference:nc OR 'conference abstruse':it OR 'briefing newspaper'/de OR 'conference paper':it OR 'conference proceeding':pt OR 'conference review':it OR congress:nc OR editorial/de OR editorial:it OR erratum/de OR letter:it OR notation/de OR note:it OR meeting:nc OR sessions:nc OR 'short survey'/de OR symposium:nc)

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#25 AND ('systematic review'/de OR 'meta analysis'/de OR (systematic* NEAR/2 review*) OR metaanalysis OR 'meta analysis' OR Cochrane)

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#26 to English, human, py:2010-2020

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Combine sets

#xv OR #19 OR #27

Page last reviewed September 2020

Page originally created August 2020

Internet Citation: Research Protocol: Interventions To Decrease Hospital Length of Stay. Content final reviewed September 2020. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, Doctor.
https://effectivehealthcare.ahrq.gov/products/hospital-length-of-stay/protocol

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Source: https://effectivehealthcare.ahrq.gov/products/hospital-length-of-stay/protocol

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