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CompletedNCT01422811Updated Jul 3, 2018

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

A Phase 3 interventional study of Multicomponent strategy to reduce avoidable length of stay and No intervention in Hospitalization and Length of Stay, sponsored by Azienda Ospedaliero-Universitaria di Parma. Completed at 1 site in Italy. Per ClinicalTrials.gov, last updated 2018-07-03.

Sponsored by Azienda Ospedaliero-Universitaria di Parma · Phase 3, Interventional, and Health services research

Phase
Phase 3
Study type
Interventional
Enrollment
3,862
Allocation
Randomized
Sex
All
01

Study 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.
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Conditions studied

  • Hospitalization
  • Length of Stay

Keywords

  • Public health
  • Policy
  • Training
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In context

Lead sponsor

Azienda Ospedaliero-Universitaria di Parma is the lead sponsor of 43 studies on the registry; 13 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
All
Accepts healthy volunteers
No

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

Exclusion Criteria:

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

Phase
Phase 3
Primary purpose
Health services research
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Outcomes assessor)
Enrollment
3,862 participants (actual)

Study arms

  • Experimental
    Intervention

    Behavioral: Multicomponent strategy to reduce avoidable length of stay

  • Other
    Control

    No Intervention

    Other: No intervention

Interventions

  • BehavioralMulticomponent 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.

  • OtherNo intervention

    No interventions (reporting, auditing) are planned; nevertheless control ward physicians know study aims and are informed about their patient's data collection.

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What researchers measure

Primary outcomes

  1. Percentage of patient-days compatible with discharge

    Time frame: 12 month period [02/2008 - 02/2009] +1 follow up month [02/2010]

Secondary outcomes

  1. Overall length of stay (in days)

    Overall length of stay = discharge date - admission date

    Time frame: 12 month period [02/2008 - 02/2009]

07

Study locations

1 site
  • Azienda Ospedaliero-Universitaria di Parma
    Parma, 43126, Italy
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References and documents

Publications

  • Carey MR, Sheth H, Braithwaite RS. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med. 2005 Feb;20(2):108-15. doi: 10.1111/j.1525-1497.2005.40269.x. PubMed 15836542 ↗
  • Lagoe RJ, Westert GP, Kendrick K, Morreale G, Mnich S. Managing hospital length of stay reduction: a multihospital approach. Health Care Manage Rev. 2005 Apr-Jun;30(2):82-92. doi: 10.1097/00004010-200504000-00002. PubMed 15923910 ↗
  • Moro ML. Health care-associated infections. Surg Infect (Larchmt). 2006;7 Suppl 2:S21-3. doi: 10.1089/sur.2006.7.s2-21. PubMed 16895497 ↗
  • Selker HP, Beshansky JR, Pauker SG, Kassirer JP. The epidemiology of delays in a teaching hospital. The development and use of a tool that detects unnecessary hospital days. Med Care. 1989 Feb;27(2):112-29. doi: 10.1097/00005650-198902000-00003. Erratum In: Med Care 1989 Aug;27(8):841. PubMed 2918764 ↗
  • 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. PubMed 10410639 ↗
  • Shojania KG, Wald H, Gross R. Understanding medical error and improving patient safety in the inpatient setting. Med Clin North Am. 2002 Jul;86(4):847-67. doi: 10.1016/s0025-7125(02)00016-0. PubMed 12365343 ↗
  • 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. PubMed 15317271 ↗
  • 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. PubMed 23305251 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 3, 2018, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT01422811
Lead sponsor
Azienda Ospedaliero-Universitaria di Parma
Collaborators
Regione Emilia-Romagna
Responsible party
Caterina Caminiti (Dr., Azienda Ospedaliero-Universitaria di Parma) — Principal investigator
First posted
Aug 24, 2011
Start date
Feb 2008
Primary completion
Feb 2009
Completion
Feb 2010
Last update
Jul 3, 2018

Study contacts

Caterina Caminiti
principal investigator · Azienda Ospedaliero-Universitaria di Parma

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Jul 2018. You cannot join it, but the record below documents what was studied.

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