Research finds patients have shorter stays at less busy hospitals after emergency surgery
New research has made the "surprising" finding that patients treated at low volume hospitals have shorter length of stay after emergency surgery and may be discharged earlier than from high volume hospitals.
The research, which looked at 8120 hospital episodes across 24 public hospitals, concluded that "concentration of services to larger clinical departments may not necessarily reduce length of stay (LOS) and improve the efficiency of resource utilisation and service delivery".
Entitled 'Variation in Hospital Length of Stay Based on Hospital Volume: A Retrospective Cohort Study of Emergency Abdominal Surgery in Ireland', the study was conducted by a team led by Jan Sorensen, Professor of Health Economics, Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland.
In the mix of public hospitals, seven were categorized as low volume, nine as medium volume, and eight as high-volume hospitals.
The majority of patients undergoing the procedures that were analysed for the study were female, while patients admitted to high volume hospitals were 1.7 years older relative to the other hospitals. More patients in high volume hospitals also had medical cards, while high volume hospitals had more patients admitted from other hospitals and more patients with comorbidities.
According to the research: "The mean total LOS was significantly longer in high volume hospitals (24.7 days), relative to low and medium volume (18.2 days, and 18.6 days)."
It also found that the mean pre-operative LOS and post-operative LOS was significantly longer at high volume hospitals, while the mean ICU (intensive care unit) LOS was significantly higher at low volume hospitals.
"Our analysis demonstrates a considerable LOS advantage when patients are treated in low volume hospitals," it said, adding that reconfiguration of resources for high-risk emergency surgery may be necessary, through improved governance for Emergency abdominal surgery (EAS)."
The authors said there were some limitations in the study, but added: "Centralisation of EAS services has occurred to a variable extent in Ireland, with higher-risk patients transferred to larger hospitals in some, but not all, hospital groups. Our health system lacks unique patient identifiers, and one limitation of our dataset is incomplete information about transferred patients.
Shorter LOS in low volume hospitals may be due to more complex patients being transferred to other institutions. Similarly, longer LOS in high volume hospitals may be due to the limited available capacity at step-down facilities, resulting in patients ‘bed blocking’ until discharge.
It concluded: "Our findings indicate that patients treated at low volume hospitals have shorter LOS and may be discharged earlier than from high volume hospitals. This finding is surprising, suggesting that concentration of services to larger clinical departments may not necessarily reduce LOS and improve the efficiency of resource utilisation and service delivery.
"EAS patients are discharged earlier from low volume hospitals, than larger volume hospitals. This suggests that service concentration to larger clinical departments may not necessarily reduce LOS and therefore may have little influence on improving the efficiency of resource consumption.
Reconfiguration of EAS services and more efficient resource allocation may reduce the observed variation in adjusted LOS measures. However, large specialised hospitals may have better opportunities to retain and recruit staff, particularly surgical specialists, to high-volume departments.
"These departments may also have better opportunities to provide more efficient services and explore economies of scale to provide less costly, high quality care. Better analyses of these aspects are needed to support the debate about restructuring emergency surgical services."
