title: Prolonged patients' In-Hospital Waiting Period after discharge eligibility is associated with increased risk of infection, morbidity and mortality: a retrospective cohort analysis.
abstract: BACKGROUND
  Prolonged, inappropriate hospital stay after patients' eligibility for discharge from internal medicine departments is a world-wide health-care systems' problem. Nevertheless, the extent to which such surplus hospital stays are associated with infectious complications, their time frame of appearance and their long-term implications was not previously addressed.
  
  
  METHODS
  We conducted a retrospective cohort analysis of patients experiencing an In-hospital Waiting Period (IHWP) after discharge eligibility in a single, tertiary hospital.
  
  
  RESULTS
  We screened the records of 245 patients out of which 104 patients fulfilled our inclusion criteria. The mean length of IHWP was 15.7 ± 4.79 day during which 9(8.7 %) patients died. The study primary composite end-point, in-hospital mortality or hospital acquired infection (pneumonia, UTI or sepsis) occurred in 32(31 %) patients. The most hazardous time was during the first 3 IHWP days: 63.7 % of patients experienced a complication and 44 % of the total complications occurred during this period. The occurrence of any complication during IHWP was associated, with statistical significance, with increased risk of mortality during the first year after IHWP initiation (HR = 6.02, p = 0.014).
  
  
  CONCLUSIONS
  Prolongation of hospital stay after patients are deemed to be discharged from internal medicine departments is associated with increased morbidity and mortality, mainly during the first surplus days of in-hospital stay. Efforts should be made to shorten such hospital stays as much as possible.
authors.affiliation: Department of internal medicine "T', Chaim Sheba Medical Center@, Ramat Gan, Israel. mayabarel@yahoo.com.
authors.forename: Maya
authors.initials: M
authors.lastname: Rosman
authors.affiliation: Department of Nursing Management, Chaim Sheba Medical Center@, Ramat Gan, Israel. orna.rachminov@sheba.health.gov.il.
authors.forename: Orna
authors.initials: O
authors.lastname: Rachminov
authors.affiliation: Sackler faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. omersgl@gmail.com.
authors.forename: Omer
authors.initials: O
authors.lastname: Segal
authors.affiliation: Department of internal medicine "T', Chaim Sheba Medical Center@, Ramat Gan, Israel. gad.segal@sheba.health.gov.il.
authors.forename: Gad
authors.initials: G
authors.lastname: Segal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000209:etiology*; D004608:Eligibility Determination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D010351:Patient Discharge; D011014:Pneumonia / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D018805:Sepsis; D013997:Time Factors