Managing Patient Length of Stay Better Using an Appropriateness Tool

Abstract

A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.

Does the Availability of Hospital Beds Affect Utilization Patterns? The Case of End-of-Life Care

“…As beds reopened, in-patient deaths increased in number, as did the average length of stay for dying in-patients. Only a few other investigations have identified availability of hospital beds as a factor in hospital admissions or other hospital utilization measures (Fisher et al, 2000;Kaplow et al, 1998). Most concentrate on the rising incidence of hospital utilization by seniors, or by chronically ill or dying patients (Anderson et al, 1990;Barer et al, 1995;Black et al, 1995;Hertzman et al,1990;Johansen et al, 1994;.…”

Does the availability of hospital beds affect utilization patterns? The case of end-of-life care

“…As beds reopened, in-patient deaths increased in number, as did the average length of stay for dying in-patients. Only a few other investigations have identi®ed availability of hospital beds as a factor in hospital admissions or other hospital utilization measures (Fisher et al, 2000;Kaplow et al, 1998). Most concentrate on the rising incidence of hospital utilization by seniors, or by chronically ill or dying patients (Anderson et al, 1990;Barer et al, 1995;Black et al, 1995;Hertzman et al, 1990;Johansen et al, 1994;.…”

Psychiatric Diagnoses of 901 Inpatients Seen by Consultation-Liaison Psychiatrists at an Academic Medical Center in a Managed Care Environment

“…Managed care reimbursement systems (e.g., capitation-based models) are funded on a "per member per month" cost system and often employ inpatient hospitalists and use other methodological incentives to minimize the utilization of inpatient care (the most cost-intensive care), resulting in shorter lengths of stay. 28,[32][33] We sought to examine whether the rate of psychiatric consultations, as a fraction of total admissions, was affected by these contemporary incentives. We also undertook this study to examine if referral rates and overall diagnostic trends in psychiatric consultation patients seen in prior studies still held true in the era of DSM-IV/DSM-IV-TR and managed care, or if a new pattern of referral and diagnosis may be emerging.…”