Length of hospital stay remains one of the greatest variables between acute trusts. By reviewing and influencing discharges commissioners can aim to improve the patient experience and save bed days, increasing capacity and saving money.
This Data Briefing measures the success of commissioners in these reductions through an analysis of variation between former strategic health authorities, over time and between diagnoses.
The first chart shows performance in England to the fourth quarter of 2005-06, through a standardised index for excess bed days, where England = 100. The range is from 91 for South West Peninsula to 112 for Northumberland Tyne and Wear. Cumbria and Lancashire showed the biggest improvement (-3.1 per cent) while Northumberland Tyne and Wear's last place was the result of an increase in excess bed days of 8.1 per cent.
The second chart shows a national reduction in the average length of stay from Q4 2001-02 to Q4 2005-06 of 2.6 days. The fickle behaviour of trusts around the end of the financial year remains evident, with low length of stay in Q2 each year following high figures in Q1.
The third chart picks a representative sample of diagnoses and lists the SHAs with the highest and lowest length of stay in days. Taking non-specific chest pain as an example, North East London and Hampshire and Isle of Wight SHAs treated similar numbers (1,620 and 1,521 respectively) but the latter has an average length of stay twice that of the former.
There does not seem to be any correlation with volume, either. For biliary tract disease the length of stay in Cheshire and Merseyside was 5.7 days (for 1,297 diagnoses) and just 3.6 days (for 805 diagnoses) in Thames Valley. For acute myocardial infarction length of stay was 11.8 days (for 574 diagnoses) in Avon, Gloucestershire and Wiltshire and just 6.9 days (for 857 diagnoses) in Norfolk, Suffolk and Cambridgeshire.
One of the points that emerge from this analysis is the potential for compartmentalising combinations of certain diagnosis and length of stay to provide a more meaningful picture. Research at Dr Foster is exploring the classification of certain episodes of care into 'long stayers', 'short stayers' etc - the aim being to enable commissioners and providers to concentrate efforts more accurately in certain areas.
D r Marc Farr is market development manager at Dr Foster Intelligence (phone 020-7330 0472 or visit www.drfosterintelligence.co.uk).