FACTORS RESPONSIBLE FOR PROLONGED PATIENT’S HOSPITALIZATION IN SURGICAL WARD OF LAGOS STATE UNIVERSITY TEACHING HOSPITAL

ABSTRACT

The study was aimed at investigating the factors responsible for prolonged patient’s hospitalization in surgical ward of Lagos state university teaching hospital. The survey research was used in this study to sample the opinion of respondents. This method involved random selection of respondent who were administered with questionnaires. The target population of the study comprised of patients of selected surgical wards in Lagos state university teaching hospital. The questionnaire administered was one hundred and ten (110) copies and one hundred copies retrieved which constitute the sample size. The descriptive and analytical approach was adopted using Chi-square to test and analyze the hypotheses earlier stated. The findings revealed that Type of surgery significantly influences the patient’s prolonged hospitalization in surgical ward of Lagos state University teaching hospitaland that there is a significant relationship between a patient length of stay and the cause of hospitalization in Lagos state University teaching hospital. It was therefore concluded from the findings that planned and timely admission and discharge of patients and offering necessary training at time of discharge along with management of stay in hospital may prevent prolonged length of stay and re-admission. It was recommended that patients with surgery warrant great attention to improve patients’ treatment outcomes or reduce in-hospital mortality.

CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF THE STUDY

Hospitals are an important part of a health system that, in coordination with other parts, provides health to the community. In fact, hospitals have a key role in providing health services; therefore, they have a major impact on the efficiency of a health system (Asefzadeh, 2010). The most important tool for evaluating hospital performance is hospital indicators. Among these indicators, length of stay (LOS) in a hospital is one of the most important and simplest indicators that is widely used today. This indicator is used for different goals, including management of hospital care, quality control, appropriateness of using hospital services, and hospital planning (Atienza, García-Heras, Muñoz-Pichardo & Villa, 2008). Length of stay in a hospital is the time interval between admission and discharge from the hospital and evaluates bed occupancy and efficiency of hospital wards (Ravangard, Arab, Zeraati, Rashidian, Akbarisari & Mostaan, 2011). With little attention to annual cost of hospital beds without considering unavoidable costs, the amount of ineffective and imposed costs, which are forced into a health system because of inappropriate stay of patients, will be determined (Schoen, Osborn, How, Doty & Peugh, 2009). To reduce hospital costs, different parts of health systems vigorously try to reduce unnecessary length of stay of patients (Siskou, Kaitelidou, Economou, Kostagiolas, Liaropoulos, 2009). However, it must be considered that overstaying of patients or staying less than what is really required affects the cost and quality of provided care. Excessive hospitalization increases use of limited resources and cost, while under-hospitalization causes unsatisfactory outcomes in treatment (Mawajdeh, Hayajneh & Al-Qutob, 2017). Thus reducing the inappropriate stay of patients in a hospital not only decreases cost and improves hospital performance but also reduces false bed occupancy rate and increases hospital productivity (Haqgoshayi & Narimani, 2012). 

Patients with prolonged length of stay are also at higher risks of nosocomial infections and unplanned readmissions [Schneider et al, 2010; Jannasch et al, 2015]. In short, prolonged length of stay disadvantages both hospitals and patients [Freitas et al, 2012]. Surgical services represent approximately 30% of all hospital expenses [Haider et al, 2015] and elective surgeries are far more common than emergency operations [Macario et al, 2017]. Unlike emergency admissions where it is difficult for hospital administrators to influence pre-admission factors, knowing the factors that increase length of stay in elective surgeries can allow hospital staff to proactively manage the delivery of care and demand for beds [Pattakos, 2011].

When attempting to reduce the length of stay, it is important not to offset the benefits by the cost, both in terms of patient complications as well as hospital resources, by readmission or utilization of outpatient facilities. It is therefore critical to monitor unplanned readmission rates in any study of the length of hospital stay. Strategies to reduce the length of stay safely include the identification of modifiable risk factors of prolonged hospitalization. Variables with potential for modification include time of exit from the operation theatre (OT), which, if planned to occur in the morning when scheduling the operative list, could expedite patient discharge.

By assessing the simultaneous impact of these factors on prolonged length of stay, hospitals can set reasonable preoperative expectations for patients and the healthcare team, establish efficient operative protocols, or plan postoperative treatment care and improve discharge planning for patients. Our approach is more likely to yield a comprehensive surgical services protocol for the entire perioperative care continuum for elective HPB and NS patients. The objective of this study is to assess the association between preoperative, intraoperative, and postoperative factors on prolonged length of stay after adjusting for surgical complexity for a sample of elective HPB and NS patients. Since surgeries are more susceptible to the risk of adverse events than non-surgical procedures [Kable et al, 2002; Zegers et al, 2011] and elective surgeries outnumber emergency procedures, we contribute to the literature on surgical safety and quality of care with greater impact for potential policy interventions that influence length of stay. Prolonged patient hospitalization is an important outcome as a marker of resource consumption. Determining which factors increase length of stay may provide information on reducing costs and improving the delivery of care.

1. STATEMENT OF THE PROBLEM

Patients with prolonged hospitalization were exposed to risk of complications including hospital acquired infections which result in morbidities and mortalities. Additionally, these unnecessary days of hospitalization result in economic burden, taking a large amount of in-patient care such as by doctors as well as nursing care; it also contributes to the high costs of health care. It is likely that these problems will be increased in the future. Identification and mitigation of the factors that affect an unnecessarily prolonged length of stay were important, because some factors could be prevented and managed by improving quality of health care system and ancillary services. There were, however, a few studies, which reported the reasons and predictive factors of inappropriate hospital days in teaching hospitals.In recent years there has been considerable interest in controlling hospital costs.Thus, it is of importance to determine which factors influence these costs. A clear determinant of resource use will be length of hospital stay. The purpose of our study was to evaluate those factors that result in prolonged hospital stay after surgery. To this end, multiple clinical, angiographic, and intraoperative factors as well as multiple complications were used to predict length of stay.

1.3. AIMS AND OBJECTIVES OF THE STUDY

The major aim of the study is to evaluate factors responsible forprolonged patient’s hospitalization in surgical ward of Lagos state university teaching hospital. Other specific objectives are as follows;

1. To examine the prevalence of prolonged patient hospitalization in surgical ward of Lagos state university teaching hospital.
2. To identify the causes of prolonged patient hospitalization in surgical ward of Lagos state university teaching hospital.
3. To examine the predictive factors of prolonged patient hospitalization in surgical ward of Lagos state university teaching hospital.
4. To examine the cost of prolonged patient hospitalization in surgical ward of Lagos state university teaching hospital.
5. To examine the relationship between a patient length of stay and the cause of hospitalization in Lagos state University teaching hospital.
6. To recommend possible interventions to improve the caring system for hospitalized patients in surgical ward of Lagos state teaching hospital.

1.4. RESEARCH QUESTIONS

1. How isthe prevalence of prolonged patient hospitalization in surgical ward of Lagos state university teaching hospital?
2. What are the causes of prolonged patient hospitalization in surgical ward of Lagos state university teaching hospital?
3. What arethe predictive factors of prolonged patient hospitalization in surgical ward of Lagos state university teaching hospital?
4. What is the cost of prolonged patient hospitalization in surgical ward of Lagos state university teaching hospital?
5. What is the relationship between a patient length of stay and the cause of hospitalization in Lagos state University teaching hospital?
6. What are the possible interventions to improve the caring system for hospitalized patients in surgical ward of Lagos state teaching hospital?

1.5. RESEARCH HYPOTHESES

Hypothesis 1

H0: Type of surgery does not influence the patient’s prolonged hospitalization in surgical ward of Lagos state University teaching hospital

H1: Type of surgery significantly influences the patient’s prolonged hospitalization in surgical ward of Lagos state University teaching hospital

Hypothesis 2

H0: There is no relationship between a patient length of stay and the cause of hospitalization in Lagos state University teaching hospital

H1: There is a significant relationship between a patient length of stay and the cause of hospitalization in Lagos state University teaching hospital

1.6. SIGNIFICANCE OF THE STUDY

This study was useful in generating facility specific information and recommendations to the management of Lagos state university teaching hospital. However other outpatient facilities with a similar set up can also benefit by customizing to suit their facilities. An understanding of the factors associated with prolonged length of stay may help to enhance systems and operational changes in facilities and as a result improve patients’ experience and shorten patient length of stay after surgery. In addition, any gaps identified in human resource management, infrastructure and internal processes can be addressed. Policies can be formulated specifically for stand-alone patient clinics especially within institutions to address patient length of stay after surgery.

1.7. DELIMITATION/SCOPE OF THE STUDY

Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

The study is restricted to the factors responsible for prolonged patient’s hospitalization in surgical ward of Lagos state university teaching hospital.

1.8 DEFINITION OF TERMS

Prolonged Hospitalization: Prolonged hospitalization which is defined as inpatient stay that exceeds the expected length of stay for a certain procedure, unnecessarily utilizes hospital beds, contributing to capacity shortage.

Hospitalization: Hospitalization is admittance to the hospital as a patient. The condition of being hospitalized

Surgical Ward: The surgical ward takes care of patients with surgical conditions which include laminectomy, craniotomy, septoplasty, appendectomy, hysterectomy, maxillofacial surgery among others.

Hospital: An institution providing medical and surgical treatment and nursing care for sick or injured people.