title: Impact of long-stay beds on the performance of a tertiary hospital in emergencies.
abstract: OBJECTIVE
  To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital.
  
  
  METHODS
  For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression.
  
  
  RESULTS
  Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index - 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) - the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days.
  
  
  CONCLUSIONS
  Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pazin-Filho
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Edna
authors.initials: E
authors.lastname: de Almeida
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Leni Peres
authors.initials: LP
authors.lastname: Cirilo
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Frederica Montanari
authors.initials: FM
authors.lastname: Lourençato
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Lisandra Maria
authors.initials: LM
authors.lastname: Baptista
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: José Paulo
authors.initials: JP
authors.lastname: Pintyá
authors.affiliation: Departamento Regional de Saúde XIII, Secretaria de Saúde do Estado de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Ronaldo Dias
authors.initials: RD
authors.lastname: Capeli
authors.affiliation: Departamento Regional de Saúde XIII, Secretaria de Saúde do Estado de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Sonia Maria Pirani Felix da
authors.initials: SM
authors.lastname: Silva
authors.affiliation: Departamento Regional de Saúde XIII, Secretaria de Saúde do Estado de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Claudia Maria
authors.initials: CM
authors.lastname: Wolf
authors.affiliation: Departamento Regional de Saúde XIII, Secretaria de Saúde do Estado de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Marcelo Marcos
authors.initials: MM
authors.lastname: Dinardi
authors.affiliation: Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Sandro
authors.initials: S
authors.lastname: Scarpelini
authors.affiliation: Departamento Clínico-Cirúrgico, Faculdade de Medicina do ABC, São Paulo, SP, Brasil.
authors.forename: Maria Cecília
authors.initials: MC
authors.lastname: Damasceno
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D009313:National Health Programs; D010343:Patient Admission; D010360:Patient Transfer / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*