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Unnecessary, Avoidable Lengths of Stay: a Strategy for Clinician Empowerment and Effectiveness Evaluation

This study has been completed.
Sponsor:
Collaborator:
Regione Emilia-Romagna
Information provided by (Responsible Party):
Caterina Caminiti, Azienda Ospedaliero-Universitaria di Parma
ClinicalTrials.gov Identifier:
NCT01422811
First received: August 23, 2011
Last updated: NA
Last verified: August 2011
History: No changes posted
  Purpose
  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.

Condition Intervention Phase
Hospitalization
Length of Stay
 Behavioral: Multicomponent strategy to reduce avoidable length of stay
Other: No intervention
 Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Health Services Research
Official Title: Unnecessary, Avoidable Lengths of Stay: a Strategy for Clinician Empowerment and Effectiveness Evaluation

Further study details as provided by Azienda Ospedaliero-Universitaria di Parma:

Primary Outcome Measures:
  • Percentage of patient-days compatible with discharge [ Time Frame: 12 month period [02/2008 - 02/2009] +1 follow up month [02/2010] ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall length of stay (in days) [ Time Frame: 12 month period [02/2008 - 02/2009] ] [ Designated as safety issue: No ]
    Overall length of stay = discharge date - admission date


Enrollment: 3862
Study Start Date: February 2008
Study Completion Date: February 2010
Primary Completion Date: February 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Intervention Behavioral: Multicomponent strategy to reduce avoidable length of stay

The strategy comprises two integrated components:

  1. Distribution of two monthly reports, one consisting in the list of patients who, through data collection performed, are classified to be present on the ward although their clinical status is considered compatible with discharge; the other featuring individual length of stay profiles for each physician operating in the intervention arm (information taken from administrative data), allowing comparisons with the rest of the medical staff;
  2. Audits performed by professionals of each ward of the intervention arm designed to discuss cases judged to be compatible with discharge. The organization of this work are left to the wards, without any interference from the project team.
No Intervention: Control Other: No intervention
No interventions (reporting, auditing) are planned; nevertheless control ward physicians know study aims and are informed about their patient's data collection.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
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
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01422811

Locations
Italy
Azienda Ospedaliero-Universitaria di Parma
Parma, Italy, 43126
Sponsors and Collaborators
Azienda Ospedaliero-Universitaria di Parma
Regione Emilia-Romagna
Investigators
Principal Investigator: Caterina Caminiti Azienda Ospedaliero-Universitaria di Parma
  More Information

Additional Information:
Study sponsor's website [ita]  This link exits the ClinicalTrials.gov site
Sponsor funding agency [ita]  This link exits the ClinicalTrials.gov site
Institution's web site  This link exits the ClinicalTrials.gov site

Publications:

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Responsible Party: Caterina Caminiti, Dr., Azienda Ospedaliero-Universitaria di Parma
ClinicalTrials.gov Identifier: NCT01422811     History of Changes
Other Study ID Numbers: aopr-rct-los
Study First Received: August 23, 2011
Last Updated: August 23, 2011
Health Authority: Italy: Regione Emilia Romagna

Keywords provided by Azienda Ospedaliero-Universitaria di Parma:
Public health
Policy
Training

ClinicalTrials.gov processed this record on May 22, 2013