[The second chart. A retrospective critical analysis of hospital stays of long duration in a public plastic surgery department].

A nine-month retrospective survey related to the long-duration hospital stays was carried out in our plastic surgery department. Twenty five patients were concerned by a more than 21 days hospitalization, the sum of which reached 1,098 days. These figures corresponded to 1.4% of the patients and 14.5% of the hospitalization days. A critical analysis was based on four principles: 1--a plastic surgery department is exclusively devoted to plastic surgery, 2--nursing cares required by the healing of a soft tissues defect don't usually need hospitalization, 3--even if it has a wide surface and/or if it is located on the lower limbs, a skin graft doesn't usually require more than ten days of hospitalization, 4--without complications, a free tissue transfer doesn't usually require more than 15 days of hospitalization. Application of these principles showed that 633 days (58%) could have been theoretically spared. Consequently, it could have permitted to treat a greater number of patients. The cause of delaying patient exit was related to the surgeon in all but one cases. It was associated in 16% of cases with a bed shortage in the convalescent or nursing homes. As hospitalization durations longer than 25 days seemed unwarranted to the authors even in the most complex cases, they suggest a simple way to alert surgeons of their department to the long-duration stays. As the department patient's chart represents 13 days of hospitalization, they ask surgeons make a decision upon planning the exiting of patients before adding a second chart.