Journal article
The expedited discharge of patients with multiple traumatic rib fractures is cost-effective
Injury, v 50(1), pp 109-112
Jan 2019
PMID: 30482588
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
•This study examines the cost-effectiveness of an expedited discharge pathway for patients admitted with multiple rib fractures.•Essential components of the pathway included aggressive pain management, pulmonary toilet, and early goal setting.•The majority of patients met the expedited discharge goal of discharge within 3 days of admission.•Advanced age was the most significant predictor of failing to meet the expedited discharge goal.•Those achieving the goal of expedited discharge had significantly lower overall costs of hospitalization.
Introduction: Rib fractures are a cause of significant morbidity and mortality in trauma patients. It is well documented that optimizing pain control, mobilization, and respiratory care decreases complications. However, the impact of these interventions on hospital costs and length of stay is not well defined. We hypothesized patients with multiple rib fractures can be discharged within three hospital days resulting in decreased hospital costs.
Methods: A retrospective review of adult patients (≥18yrs) admitted to our Level 1 trauma center (2011–2013) with ≥2 rib fractures was performed. Patients were excluded if they were intubated, admitted to the ICU, required chest tube placement, or sustained significant multi-system trauma. (n = 202) Demographics, clinical characteristics, hospital costs, and outcome data were analyzed. Patients discharged within three hospital days of admission were considered to have achieved expedited discharge (ED). Univariate and multivariate analyses determined predictors of failure to achieve ED. A p value of <0.05 was considered significant.
Results: Study patients (n = 202) were 60 (SD = 19) years of age with an injury severity score (ISS) of 10 (SD = 5), and 4 (SD = 2) rib fractures. Of 202 patients, 127 (63%) achieved ED while 75 (37%) did not. No differences in chest AIS, ISS, smoking status or history of pulmonary disease were identified between the two groups (all p > 0.05). Average LOS (2 (SD = 1) vs. 7 (SD = 4) days; p < 0.001) and hospital costs ($2865 (SD = 1200) vs. $6085 (SD = 3033)); p < 0.001). were lower in the ED group A lower percentage of ED patients required placement in rehabilitation facilities (6% vs. 48%; p < 0.001). There were no readmissions within 30 days in either group. After controlling for potential confounding variables, multiple variable logistic regression analysis revealed that advancing age (OR 1.05 per year, 1.02–1.07) independently predicted failure to achieve ED.
Conclusion: The majority of patients admitted to the hospital with multiple rib fractures can be discharged within three days. This expedited discharge results in significant cost savings to the hospital. Early identification of patients who cannot meet the goal of expedited discharge can facilitate improvement in management strategies.
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Details
- Title
- The expedited discharge of patients with multiple traumatic rib fractures is cost-effective
- Creators
- Michael K. Dalton - Saint Barnabas Medical CenterMichael J. Minarich - Cooper University HospitalKimberly J. Twaddell - Cooper University HospitalJoshua P. Hazelton - Cooper University HospitalNicole M. Fox - Cooper University Hospital
- Publication Details
- Injury, v 50(1), pp 109-112
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Nurse Practitioner Master of Science in Nursing (MSN); Surgery
- Web of Science ID
- WOS:000454717700020
- Scopus ID
- 2-s2.0-85055479301
- Other Identifier
- 991021890009004721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Critical Care Medicine
- Emergency Medicine
- Orthopedics
- Surgery