Day of Admission Dictates Length of Stay for Heart Failure

WEDNESDAY May 21, 2008 -- Heart failure patients admitted to the hospital on Thursdays or Fridays have longer hospital stays than those admitted on other days of the week, a new report found.

Those admitted on Tuesdays have the shortest stays.

Unlike heart attack patients, however, the day of admission doesn't seem to effect death rates for heart failure patients, according to the report, published in a new journal, Circulation: Heart Failure, which debuts this week.

"The day of the week appeared to significantly influence whether a [heart failure] patient would be discharged," said study lead author Dr. Gregg D. Fonarow, professor of cardiovascular medicine at the University of California, Los Angeles, David Geffen School of Medicine. "There were far fewer discharges over weekends and specifically on Sundays."

The findings could lead to changes in hospital procedures, such as staffing schedules, which could lead to shorter hospital stays and reduced costs, the authors said.

Previous studies had found that heart attack patients admitted to a hospital on weekends were more likely to die than those admitted on weekdays. "On weekends, there tend to be less physicians and nurses and other health personnel, less senior individuals and supervisors," Fonarow explained. "Often physicians covering many patients were not involved in directly admitting those patients."

Heart failure -- the heart's inability to pump sufficient amounts of blood -- is one of the leading reasons for hospitalizations (at least 3.6 million annually) in the United States. But until the new study, no review had been done to see if the day of admission affected outcomes, the study authors said.

Fonarow and his colleagues looked at data for a sample of 48,612 heart failure patients admitted to 259 hospitals across the United States. While death rates were similar for all seven days of the week, length of hospital stays differed from 5.39 days for those admitted on Tuesdays to 5.88 days for those admitted on Fridays.

Hospitalizations that started on Sundays, Mondays or Tuesdays had the shortest duration, while those starting on Thursdays or Fridays had the longest. Heart failure patients were most likely to be discharged on a Friday and least likely to be discharged on a Sunday. That means that some patients who were ready to be discharged on a weekend were held over.

Dr. John P. Erwin III is an assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine and senior staff cardiologist at Scott & White Hospital in Temple. Discussing the new findings, he said that hospitals participating in clinical trials like those included in the study are more likely to pay close attention to patients. "We don't know if this [the study findings] can be generalized to the majority of hospitals," he said. "Patients enrolled in a study have closer follow-up and closer adherence to getting the right drugs."

Changing hospital staffing patterns could shave $360 million off the $33.2 billion annual price tag for heart failure care by reducing lengths of stay, the study authors suggested. For one hospital with 1,000 heart failure hospitalizations a year, it might save $330,000 or more, they said.

"This would be something that would be really amenable to change," Fonarow said. "A shift in staffing and philosophy to facilitate weekend discharges should be readily achievable."

Many hospitals may already be looking into this, he said.

"Most hospitals do run a little bit tighter staffing nights and weekends, [but] over the last three to five years, most hospitals have been actually addressing this as part of safety and quality improvement initiatives, realizing that patients are sick 24/7, and we need to make sure we have adequate amounts of staffing for hospitals," Fonarow said.

Posted: May 2008


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