Published: 10/03/2005, Volume II5, No. 5946 Page 23
The new public service agreement targets for the NHS include a requirement to reduce the amount of time that people spend in hospital by providing more treatment in the community. The success of this will be measured in two ways: reductions in hospital admissions and quicker discharge of those who are admitted to hospital.
The first chart shows the average length of stay in hospital by diagnosis on admission for patients aged over-65 admitted as an emergency and discharged home. Fractured neck of femur and stroke appear as the two highest. These are both conditions where there is significant scope to provide post-discharge care in the community but most patients are being discharged home after lengthy stays in acute beds.
Emergency admission for Parkinson's disease is far less common (3,000 patients compared to 40,000 for fractured neck of femur). But it is worth noting that these 3,000 patients spent an average of 20 days in hospital.
Chart 2 shows the overall bed days used for patients over-65 admitted as emergencies. The diagnoses with the longest average length of stay do not always account for the most bed use. For example, with COPD the average length of stay is lower than for other emergency diagnoses (nine days), but the total bed days used is high because of the numbers of patients admitted.
The biggest use of beds is for patients admitted with vague diagnoses. The average length of stay is shorter for these patients although still significant at seven days. However, as this is by far the most common cause of admission, the aggregate bed days used is very large. A better understanding of how these patients are treated could pay big dividends in reducing bed usage.
While many efforts to reduce length of stay focus on particular diagnoses, it may be the patients who have not yet got a clear diagnosis that are the greatest problem.
The last chart shows the difference between the top and bottom quartile length of stay for common diagnoses where the average length of stay is high.
The figures again apply to patients aged over 65 admitted as emergencies and discharged home.
Overall, the hospitals in the highest quartile keep their patients in hospital 30 per cent longer than the hospitals in the best quartile.
Considering that the average time spent in hospital by these patients is far higher in the UK than in many other health systems, the overall potential to save money by moving patients out of hospital faster is enormous.
Roger Taylor is research director at health information specialists Dr Foster.