Published: 15/07/2004, Volume II4, No. 5914 Page 22

Community beds can have a significant impact on reducing length of stay in acute wards

Patients in England spend on average 11 days in an acute hospital bed when having a hip replacement operation and, in most cases, go home afterwards. A minority of patients are transferred to another hospital for rehabilitation.

If any post-transfer stay in a community hospital is included, the national average length of stay is 12 days - community beds are so little used, the difference nationally is marginal. However, where community beds are more widely used, they can have a significant impact in reducing the length of stay in the acute ward.

The first chart shows the distribution of length of stay across trusts. The variation is considerable, regardless of whether the point of comparison is the stay in the acute bed or the total length of stay in hospital, including any transfer to a community bed.

The figures are based on the median days of length of stay for patients having a total hip replacement as recorded in the hospital episode statistics for the year to March 2003. The tables give figures for all acute trusts with more than 50 admissions recorded for hip replacement in that year.

If post-transfer spells in a community hospital are included, the average length of time in hospital varied from seven days to 17. Relatively few trusts manage to get most of their patients out in under nine days and a handful have average stays of 14 days or more.

With the introduction of payment by results there will be increasing focus on managing the cost per admission of patients such as those having hip replacements. There has often been a focus on reducing the minority of patients with very long stays in hospital. Increasingly, the effort will be focused on reducing the normal length of stay for the majority of patients.

Some hospitals managed a shorter length of stay in the acute hospital beds by having a higher rate of transfer to community facilities. In most hospitals, over 90 per cent of patients admitted for this operation were discharged home. The second chart shows the percentage of patients discharged home after their operation, with only a handful of hospitals sending more than 10 per cent of patients to another hospital.

A minority of acute hospitals are able to make use of community facilities. Ten trusts transferred more than 20 per cent of patients to another hospital after their operation. The average length of stay at these hospitals was nine days - two days less than the national average - while the total length of stay remained at 12 days.

The last chart shows the median length of stay for each trust against the percentage discharged home. There is some correlation between the two, showing that trusts which make more use of community beds can cut the time patients spend in more expensive acute beds.

The variations between trusts suggest there is significant room for greater standardisation of how patients are managed. Furthermore, greater use of less expensive community beds could free much needed capacity in acute hospitals.

Roger Taylor is research director of health information specialists Dr Foster.