title: Epidemiology of long-stay patients in a university teaching hospital.
abstract: BACKGROUND
  Patients admitted to acute care hospitals may have multiple comorbidities, and a small proportion may stay for a protracted period.
  
  
  OBJECTIVE
  To assess the proportion of hospital patients who are long stay (≥14 days) and evaluate associations with baseline variables and subsequent inpatient morbidity and mortality.
  
  
  METHODS
  This is a retrospective observational study of patients aged ≥18 years staying in hospital for at least 24 h between 1 July 2013 and 30 June 2014.
  
  
  RESULTS
  There were 22 094 admissions in 15 623 patients. The median (interquartile range (IQR)) length of stay (LOS) was 4 (2-8) days, and 10% had a LOS >16 days. Long-stay admissions comprised 13.1% of admissions but used 49.1% of bed days. Long-stay admissions were more likely to be associated with intensive care unit admission (21.2 vs 6.0%), medical emergency team review (20.5 vs 4.3%) and a longer duration of mechanical ventilation (P < 0.0001 all comparisons). Long-stay patients were more likely to develop in-hospital complications, were more likely to die in hospital (8.2 vs 3.1%) and were less likely to be discharged home (P < 0.001 all comparisons). Multiple variable analysis revealed several associations with prolonged stay, including multiple admissions in the study period, the nature of the admitting unit, the Charlson comorbidity index at admission, admission from another hospital and any history of smoking.
  
  
  CONCLUSIONS
  Patients staying at least 14 days comprised one seventh of hospital admissions but used half of bed days and suffered increased in-hospital morbidity and mortality. Several pre-admission associations with prolonged stay were identified.
authors.affiliation: Director Patient Flow, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: O'Sullivan
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.|Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Martensson
authors.affiliation: Department of Administrative Informatics, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Robbins
authors.affiliation: Intensive Care, Western Health, Melbourne, Victoria, Australia.
authors.forename: K J
authors.initials: KJ
authors.lastname: Farley
authors.affiliation: Department of General Medicine, Austin Health, Melbourne, Victoria, Australia.|Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Doug
authors.initials: D
authors.lastname: Johnson
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.|School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Daryl
authors.initials: D
authors.lastname: Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016021:Epidemiologic Studies; D005260:Female; D006784:Hospitals, Teaching / Q000639:trends*; D006785:Hospitals, University / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
keywords: long stay; morbidity; patient complexity