Aim: Analyze the average length of inpatient stays. Stays are defined by the interval between the admission of the patients and their discharges from acute somatic care hospitals. If different stays are merged for reimbursement purpose (SwissDRGs rules), each stay is taken into consideration in its original form (stay definition).

Numerator: Total of hospital days, including admission and discharge’s dates and after deduction of possible vacations’ days.

Denominator: All stays in acute somatic care units. Stays assigned to Swiss statistics codes M500, M900, M950, M990 (only if the average length of stay exceed 10 days) are excluded. Stays with a zero length of stay are also excluded (only among stays grouped according to SwissDRGs rules).

Expected values: Expected costs are computed based on average costs per diagnosis and procedure category among Swiss hospitals with high performances 2011-2014 (benchmark). Click here to learn more about our adjustment model.

Output files: Results are given by hospital and site in Length.xlsx file. There are detailed by hospital stay in Analysis.txt. General information about output files can be found here.

Interpretation: in general, length of stay should be as short as possible if this does not generate avoidable readmissions. The interpretation might differ depending on the context of the stays. Of course, this quest for quick discharge makes no sense for patients dying at the hospital. If patients are waiting for nursing home beds, the questioning is more for medico-social liaison than for medical practices. Too long stays among candidates for one-day surgery or unjustified stays suggest that ambulatory or social alternatives are not available or financially interesting. Too short length among stays followed by a potentially avoidable readmission might highlight possible premature discharges: one or two days excess among these stays is rather reassuring about the ability of teams to identify patients at risk of readmission. If the length of stay is rather long among more or less justified stays, this might suggest that a closer collaboration with installed physicians could help to shorten stays. For other stays (back to home without readmission), the length of stay depend mainly from medical practice. If such stays are too long, this might be explained by too high complications or reoperations rates; if not, medical habits is a possible cause.

Strength of the indicator: In comparisons with DRG groupers, this SQLape indicator has some advantages : more robust according to coding habits (no role of the choice of the main diagnosis for instance), clinically interpretable categories (about 200 medical groups and 180 surgical ones), a better adjustment for complex patients (multiple severe co-morbidities or interventions), no over-adjustment (complications and immediate causes of death are not taken into consideration). Last but not least, the results can be interpreted according to other indicators describing the context of the stays (see above).

Limitations: Some cantons have many rehabilitation or acute geriatric beds (up to 30% of acute somatic care beds), other very few. This might cause distortions in inter-regional comparisons. A solution might consist in aggregating acute and rehabilitation stays.