Clinical trial NCT01422811: Unnecessary, Avoidable Lengths of Stay: a Strategy for Clinician Empowerment and Effectiveness Evaluation
Official title: Unnecessary, Avoidable Lengths of Stay: a Strategy for Clinician Empowerment and Effectiveness Evaluation
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Hospitalization
Length of Stay
Keywords: Public health
Policy
Training
Lead sponsor: Azienda Ospedaliero-Universitaria di Parma
Sponsor class: OTHER
Collaborators: name: Regione Emilia-Romagna
First posted: 2011-08-24
Enrollment: 3862
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 1. Background: In recent years an increasing trend in excessive lengths of stay has been recorded at the Parma University Hospital, compared with regional mean values. Excessive lengths of stay have been demonstrated to constitute not just an economic problem, but also a clinical and public health issue. Since the measures taken at our institution so far have not proven effective, the investigators carried out a literature review, which mostly detected observational studies, restricted to the assessment of the impact of a single intervention.
2. Objectives: This project intends to evaluate the effectiveness of a multifaceted strategy aiming to empower clinicians on the issues associated with excessively long and avoidable hospital stays, and enable them to identify corrective measures (according to the principles of clinical governance).
3. Study design: cluster-randomized, parallel group, open-label, community trial
4. Methods: trained personnel will periodically record causes for excessive lengths of stay in all participating wards using an ad hoc data collection sheet. In the wards randomized to the experimental group, interventions aimed to clinician empowerment - provision of reminders and periodical audits - will be implemented.
5. Expected results: A reduction in the experimental vs. the control arm unnecessary lengths of stay is expected, although the introduced measures will also presumably lead to improvement in the wards where they are not implemented.


Eligibility criteria: Inclusion Criteria:

* patients present on the participating wards during one of 12 randomly selected index days (one for each month of data collection)

Exclusion Criteria:

* patients admitted or discharged on the index days
* patients with length of stay (interview date - admission date) \> 90 days

Primary outcomes:
measure: Percentage of patient-days compatible with discharge
timeFrame: 12 month period [02/2008 - 02/2009] +1 follow up month [02/2010]
Secondary outcomes:
measure: Overall length of stay (in days)
timeFrame: 12 month period [02/2008 - 02/2009]
Other outcomes:
Locations:
city: Parma
country: Italy
facility: Azienda Ospedaliero-Universitaria di Parma
Study officials:
affiliation: Azienda Ospedaliero-Universitaria di Parma
name: Caterina Caminiti
role: PRINCIPAL_INVESTIGATOR
References:
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citation: Setrakian JC, Flegel KM, Hutchinson TA, Charest S, Cote L, Edwardes MD, Corbett IB. A physician-centred intervention to shorten hospital stay: a pilot study. CMAJ. 1999 Jun 15;160(12):1735-7.
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citation: Meschi T, Fiaccadori E, Cocconi S, Adorni G, Ridolo E, Stefani N, Schianchi T, Novarini A, Spagnoli G, Caminiti C, Pini M, Borghi L. [Analysis of the problem of "difficult hospital discharges" in the University Hospital of Parma]. Ann Ital Med Int. 2004 Apr-Jun;19(2):109-17. Italian.
citation: Caminiti C, Meschi T, Braglia L, Diodati F, Iezzi E, Marcomini B, Nouvenne A, Palermo E, Prati B, Schianchi T, Borghi L. Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial. BMC Health Serv Res. 2013 Jan 10;13:14. doi: 10.1186/1472-6963-13-14.