Drug prescribing and its relation to length of hospital stay

The length of the patient's hospital stay (LOS) often is used as an indicator of the quality and efficiency of care in short-term hospitals. It is a patient outcome variable that can be obtained easily and measured objectively from the hospital record and, with disease aspects taken into account, can reflect the appropriateness and economy of care received in the hospital. Clearly, appropriateness of treatment has an impact on both patient status and efficiency of care. For example, oral administration of antimicrobials to a severely ill patient with a bacterial infection not only could delay recovery but also would constitute inefficient use of an acute care facility. Antimicrobials are a good illustration of this point, because they are used frequently, are costly, and often are prescribed in a pharmacologically inappropriate manner. Derived from these two facets of hospital care (drug prescribing and patient outcomes) came the specific aim of the authors research: to ascertain whether antimicrobial prescribing that is pharmacologically inappropriate is associated with a greater number of sick days than is appropriate prescribing. The other aspects of LOS also were reviewed in conjunction with antimicrobial prescribing appropriateness, since inadequacy in antimicrobial prescribing may be only one component of a more general suboptimal approach to patient care. Thus, in addition to more sick days, it was hypothesized that inappropriate prescribing, in contrast to appropriate prescribing, would be associated with more inefficient care days. Pyelonephritis (PY) and pneumococcal pneumonia (PN) were chosen as the diseases for which the pharmacological appropriateness of drug prescribing and the components of LOS would be measured. Pharmacologically inappropriate antimicrobial prescribing was related to an average of 30% more sick days for PN, but a similar relationship did not appear for PY. It was expected that this association would be stronger, since it was presumed that patients for whom prescribing was inappropriate should take longer to recover than those for whom it was appropriate. One possible answer could be that there are two types of outcomes associated with the appropriateness of drug prescribing for these diseases, the immediate and the long-term outcome, and that certain kinds of prescribing appropriateness may affect these two outcomes differently. In each of the three analyses-PN, PY, and younger subset of PY-one or more measures of the efficiency/inefficiency of care showed that pharmacologically inappropriate prescribing was associated with significantly more inefficient care (or less efficient care). This difference was substantial-in the three analyses of inefficient care, the inappropriately prescribed groups had more than 150% more days of inefficient care than the appropriately prescribed groups.