Questions Raised on Shorter Hospital Stays
CHICAGO --- Over the past decade, time spent in-hospital has
declined dramatically, even for patients with serious illnesses.
This trend raises concern that increasing numbers of patients may
be discharged before their conditions are stable, particularly
if a do-not-resuscitate (DNR) order has been written.
A Northwestern University study of Medicare patients hospitalized
with pneumonia, heart attack and stroke found that death rate after
hospital discharge increased up to 72 percent between 1991 and
1997 for patients who had a DNR order written on the first or second
day of their hospital stay.
However, for patients who did not have a DNR order, mortality
during the 30 days after discharge generally remained stable.
The study, published in the March 9 issue of the Archives of
Internal Medicine, was led by David Baker, M.D., associate professor
of medicine and chief of internal medicine at the Feinberg School
of Medicine at Northwestern University and the Northwestern Medical
Faculty Foundation.
It should be noted that, overall, Baker and his colleagues found
little evidence that shorter length of stay actually caused the
increase in post-discharge death for patients who had a DNR order.
The researchers also believe that their findings provide some
reassurance that it is possible to reduce length of stay without
jeopardizing the health of patients.
“Improvements in therapies, more rapid administration of
effective therapies, greater willingness to evaluate some medical
problems in the outpatient setting, more efficient discharge practices
and expanded use of home health care could all contribute to shorter
mean lengths of stay without cutting corners,” Baker said.
Baker also said that the increasing post-discharge death rate
in patients with early DNR orders could reflect positive changes
in end-of-life care, such as more widespread use of hospice, or
could indicate a decline in the quality of care for terminally
ill patients.
The researchers caution that additional studies are needed to
examine whether there has been a decline in in-hospital quality
of care for patients with DNR orders.
Collaborating on this study were Doug Einstadter, M.D., Scott
S. Husak, and Randall D. Cebul, M.D., of Case Western Reserve University,
Cleveland, Ohio.
The study was funded by a grant from the Agency for Healthcare
Research and Quality. |