There is growing demand for new and innovative indicators to measure variations in performance between acute trusts. Length of stay measures include indicators of excess bed days, analysis over time and giving lengths of stay for specific diagnoses or procedures..
The first chart, based on nationwide clearing returns, shows the performance in England of the newly configured strategic health authorities through a standardised index for excess bed days where the England average is 100. The seemingly small differences represent millions of pounds potentially saved or spent.
Taking the two extreme cases, NHS London has an index for excess bed days of 103.1, 3.1 per cent higher than average; NHS East of England an index of 94.5. However, both have seen dramatic improvements from the previous quarter, Q1 2006, as both indices have reduced by over 5 per cent. Better still, this reflects reductions in actual numbers of bed days of over 10 per cent for both SHAs. Odd though that the two SHAs improving quickest are the current worst and best.
The second chart shows the national reduction in average length of stay from Q3 2001 to Q3 2006. The strong seasonal pattern that this measure has traditionally shown is fading, which is not surprising as further reductions become more stubborn to achieve. A best fit line through this chart shows the clear downward trend, the latest average being 18 days down from 21 in 2002 and 2003.
The third chart shows a sample of high-volume diagnoses and the region that had the highest and lowest length of stay for each. So while pregnancy/delivery stays at NHS South Central average 1.7 days, in NHS North East, the average is 1.2 days. There are a range of other diagnoses within the 10 highest volume diagnoses which show even greater variation.
Take abdominal pain: in the West Midlands the average stay is 2.5 days; in South Central it is 1.5 days. A day does not sound much until it is multiplied by the high number of admissions for each of these in each SHA.
Length of stay remains a crucial measure for the NHS. Other ways to look at it include counting the number of pre-operative bed days and the number of emergency bed days. Each of these different numbers throw light on a different process within the NHS and will be analysed in future issues. -