Study: The Faster You Get Out of a VA Hospital, the Better Off You Are

Posted by Jason Van Steenwyk

VA medical careThat wasn’t quite the headline. The real headline is “Shorter hospital stays don’t mean worse care: study.” But they work out to the same thing.

“U.S. Veterans Affairs hospitals were able to reduce their patients’ length of stay without increasing the number of people who needed to be readmitted later on, according to a new study.

“As hospitals became more efficient there was this growing concern that we were discharging patients – as some would say – sicker and quicker,” said the study’s lead author Dr. Peter Kaboli.

“In fact, we found just the opposite,” said Kaboli, who works at the Iowa City VA Health Care System.”

The average VA hospital stay fell from 5.5 days in 2007 to 4 days in 2010. The study, published in the Annals of Internal Medicine, surveyed 4 million patient records at the Department of Veterans Affairs’ 129 hospitals nationwide from 2007-2010 to see if earlier discharges resulted in an increase in admission within 30 days.

The study shockingly found that when it came to readmissions, government health care added no value beyond the third day. More than that, the survey found that a five-day stay rather than a four-day stay was actually harmful to readmission rates: Reducing the length of stay from 5.5 days to 4 days actually reduced readmissions, from 16.5 percent in 1997 to 13.8 percent in 2010.

The survey also found that getting patients out of the VA hospital in four days rather than five and a half, on average, resulted in lower post-discharge mortality rates over the 90 days following discharge.

The sample was diverse: No specific diagnosis or medical condition accounted for more than 5 percent of the patient population. It is therefore unlikely that advances in treatment of a particular condition or disease accounted for a significant change in the numbers.

Why would patient outcomes improve with shorter hospital stays? Hospital-acquired infections, or HAI (also called nosocomial infections). Hospitals are hothouses for staph infections and other communicable diseases. Infection and reinfection accounts for a significant number of hospital readmissions within 30 days of discharge. The Center for Disease Control estimates that there are 1.7 million serious infections acquired in a hospital each year, killing almost 100,000 people per year. These infections can occur when hospital staffers do not disinfect exposed surfaces or diligently practice sound hygiene.

The Veterans Administration had, during the time of the study, also engaged in a massive, successful effort to improve hygiene at its hospitals and clinics. The effort resulted in a massive, 62 percent decrease in hospital-acquired staph infections. The initiative commenced in 2007 – the same year the study began.

13.6 percent of patients admitted who were screened for methicillin-resistant Staphylococcus aureus bacteria tested positive. This alerted VA staffers, who would isolate the patient from others and who would be extra diligent in practicing universal hygiene precautions, so as to minimize the risk of patient-to-patient and patient-to-staff-to-patient infection.

With screening at admission now commonplace, VA officials could effectively calculate how many patients acquired the infection while in the hospital. The VA estimated that there were 1.62 new infections per 1,000 patient days. The rate fell to 0.6 new infections per 1,000 patient-days. Not enough to hugely affect the VA’s readmission numbers, however.

The study also included the time period in which the VA had to inform more than 10,000 patients that they were potentially exposed to hepatitis and other infections because of faulty sanitation procedures at VA facilities in Florida, Georgia and Tennessee.

 

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