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Disability Impacts Length of Stay in General Internal Medicine Patients

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ABSTRACT

BACKGROUND

Disability is prevalent among patients treated in Internal Medicine (IM), but its impact on length of inpatient stay (LOS) is unknown. Current systems of patient management and resource allocation are disease-focused with scant attention paid to functional impairment. Earlier studies in selected cohorts suggest that disability prolongs LOS.

OBJECTIVE

To investigate the relationship of disability with LOS in IM, controlling for comorbidity.

DESIGN

Prospective cohort study.

PATIENTS

We charted 448 patients from an IM team admitted between 2008 and 2012 for sociodemographic, disease, biochemical and functional characteristics. Each IM team is on duty for one month annually, and patients were hence recruited for one month each year.

MAIN MEASURES

Disability was measured using the Functional Independence Measure (FIM) recorded at discharge. Comorbidity was measured using the Charlson Comorbidity Index (CCI).

KEY RESULTS

Of the 448 patients, 57.4 % were male with mean age 68.6 years. The mean LOS was 9.58 days. The mean motor and cognitive FIM scores were 57.1 and 25.7, respectively. The mean CCI score was 2.69. Thirty-four percent had major social issues impacting discharge plans. The five most common diagnoses for admission were pneumonia (8.9 %), urinary tract infection (7.8 %), cellulitis (7.6 %), heart failure (7.1 %) and falls (6.0 %). Both cognitive and motor FIM scores were negatively correlated with longer LOS (P < 0.001). On multivariate analysis, variables independently associated with longer LOS included the motor FIM score (P < 0.001), presence of social issues such as caregiver unavailability (P < 0.001), non-realistic patient expectations (P = 0.001) and administrative issues impeding discharge (P = 0.016).

CONCLUSION

Disability predicts LOS in IM patients, and thus their comprehensive care should involve functional assessment. As social and administrative factors were also independently associated with LOS, there is a need to involve social workers and administrators in a multidisciplinary approach towards optimizing LOS.

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Acknowledgements

(1) Contributors: All authors who contributed to the manuscript meet the criteria for authorship.

(2) Funders: This study was supported by the Department of Rehabilitation Medicine of the Singapore General Hospital.

(3) Prior Presentations: This work was presented in part as an oral presentation at the annual meeting of the Society of General Internal Medicine in Denver, Colorado on 25 April 2013.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Duke - National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore

    Chunzhen Tan BSc (Hons), Yee Sien Ng MBBS, MRCP, FAMS, Deidre A. De Silva MBBS, MRCP, FAMS, Arul Earnest PhD & Sylvaine Barbier MSc

  2. Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore

    Chunzhen Tan BSc (Hons) & Yee Sien Ng MBBS, MRCP, FAMS

  3. Saw Swee Hock School of Public Health, Singapore, Singapore

    Gerald C. H. Koh MBBS, MMed, PhD

  4. Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, Singapore, Singapore

    Deidre A. De Silva MBBS, MRCP, FAMS

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  1. Chunzhen Tan BSc (Hons)
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  2. Yee Sien Ng MBBS, MRCP, FAMS
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  3. Gerald C. H. Koh MBBS, MMed, PhD
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Correspondence to Yee Sien Ng MBBS, MRCP, FAMS.

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Tan, C., Ng, Y., Koh, G.C.H. et al. Disability Impacts Length of Stay in General Internal Medicine Patients. J GEN INTERN MED 29, 885–890 (2014). https://doi.org/10.1007/s11606-014-2815-z

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  • DOI: https://doi.org/10.1007/s11606-014-2815-z

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