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BMC Health Services Research
Published in: BMC Health Services Research 1/2008

Open Access 01-12-2008 | Research article

Benchmarking and reducing length of stay in Dutch hospitals

Authors: Ine Borghans, Richard Heijink, Tijn Kool, Ronald J Lagoe, Gert P Westert

Published in: BMC Health Services Research | Issue 1/2008

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Abstract

Background

To assess the development of and variation in lengths of stay in Dutch hospitals and to determine the potential reduction in hospital days if all Dutch hospitals would have an average length of stay equal to that of benchmark hospitals.

Methods

The potential reduction was calculated using data obtained from 69 hospitals that participated in the National Medical Registration (LMR). For each hospital, the average length of stay was adjusted for differences in type of admission (clinical or day-care admission) and case mix (age, diagnosis and procedure). We calculated the number of hospital days that theoretically could be saved by (i) counting unnecessary clinical admissions as day cases whenever possible, and (ii) treating all remaining clinical patients with a length of stay equal to the benchmark (15th percentile length of stay hospital).

Results

The average (mean) length of stay in Dutch hospitals decreased from 14 days in 1980 to 7 days in 2006. In 2006 more than 80% of all hospitals reached an average length of stay shorter than the 15th percentile hospital in the year 2000. In 2006 the mean length of stay ranged from 5.1 to 8.7 days. If the average length of stay of the 15th percentile hospital in 2006 is identified as the standard that other hospitals can achieve, a 14% reduction of hospital days can be attained. This percentage varied substantially across medical specialties. Extrapolating the potential reduction of hospital days of the 69 hospitals to all 98 Dutch hospitals yielded a total savings of 1.8 million hospital days (2006). The average length of stay in Dutch hospitals if all hospitals were able to treat their patients as the 15th percentile hospital would be 6 days and the number of day cases would increase by 13%.

Conclusion

Hospitals in the Netherlands vary substantially in case mix adjusted length of stay. Benchmarking – using the method presented – shows the potential for efficiency improvement which can be realized by decreasing inputs (e.g. available beds for inpatient care). Future research should focus on the effect of length of stay reduction programs on outputs such as quality of care.
Appendix
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Literature
1.
Clarke A, Rosen R: TI – Length of stay. How short should hospital care be?. European Journal of Public Health. 2001, 166-170. 10.1093/eurpub/11.2.166.
2.
Netherlands Board for Health Facilities (Bouwcollege): Ontwikkelingen bedgebruik ziekenhuizen. signaleringsrapport. 13-1-2003. Utrecht, Netherlands Board for Health Facilities (Bouwcollege), Ref Type: Report
3.
Netherlands Board for Health Facilities (Bouwcollege): Ontwikkelingen bedgebruik ziekenhuizen, deel 2 mogelijkheden voor verkorting van de verpleegduur. signaleringsrapport. 26-5-2003. Netherlands Board for Health Facilities (Bouwcollege), Ref Type: Report
4.
Borghans HJ, Matser W: Twee promille-beddennorm, Sterke verkorting verpleegduur is noodzaak. Zorgvisie. 1999, 5: 16-21.
5.
Brownell MD, Roos NP: Variation in length of stay as a measure of efficiency in Manitoba hospitals. CMAJ. 1995, 152: 675-682.PubMedPubMedCentral
6.
Hanning BW: Length of stay benchmarking in the Australian private hospital sector. Aust Health Rev. 2007, 31: 150-158.CrossRefPubMed
7.
Commission on Professional and Hospital Activities: Length of stay in the U.S. Ann Arbor. 1979, Commission on Professional and Hospital Activities (CPHA), Ref Type: Report
8.
Centraal Bureau voor de Statistiek (CBS): Statistische Onderzoekingen, een onderzoek naar verschillen in de verpleegduur van ziekenhuispatiënten. 1985, Voorburg/Heerlen, Centraal Bureau voor de Statistiek (CBS), Ref Type: Report
9.
Wasowicz DK, Schmitz RF, Borghans HJ, de Groot RR, Go PM: [Increase of surgical day treatment in the Netherlands] 24. Ned Tijdschr Geneeskd. 1998, 142: 1612-1615.PubMed
10.
Wasowicz DK, Schmitz RF, Borghans HJ, De Groot RRM, Go PMNY: Growth potential of ambulatory surgery in The Netherlands. Ambulatory Surgery. 2000, 8: 7-11. 10.1016/S0966-6532(99)00022-0.CrossRef
11.
Murphy ME, Noetscher CM: Reducing hospital inpatient lengths of stay 13. J Nurs Care Qual. 1999, 40-54. Spec No
12.
Suthummanon S, Omachonu VK: Cost minimization models: Applications in a teaching hospital. European Journal of operational research. 2007
13.
Lagoe RJ, Westert GP, Kendrick K, Morreale G, Mnich S: Managing hospital length of stay reduction: a multihospital approach 14. Health Care Manage Rev. 2005, 30: 82-92.CrossRefPubMed
14.
Westert GP, Berg MJvd, Koolman X, Verkleij H: Dutch Health Care Performance Report 2008. RIVM. 2008, Ref Type: Report
15.
16.
Harrison ML, Graff LA, Roos NP, Brownell MD: Discharging patients earlier from Winnipeg hospitals: does it adversely affect quality of care?. CMAJ. 1995, 153: 745-751.PubMedPubMedCentral
17.
Thomas JW, Guire KE, Horvat GG: Is patient length of stay related to quality of care?. Hosp Health Serv Adm. 1997, 42: 489-507.PubMed
18.
Westert GP, Lagoe RJ: The evaluation of hospital stays for total hip replacement. Qual Manag Health Care. 1995, 3: 62-71.CrossRefPubMed
19.
Kossovsky MP, Sarasin FP, Chopard P, Louis-Simonet M, Sigaud P, Pernege TV, Gaspoz JM: Relationship between hospital length of stay and quality of care in patients with congestive heart failure 17. Qual Saf Health Care. 2002, 11: 219-223. 10.1136/qhc.11.3.219.CrossRefPubMedPubMedCentral
Metadata
Title
Benchmarking and reducing length of stay in Dutch hospitals
Authors
Ine Borghans
Richard Heijink
Tijn Kool
Ronald J Lagoe
Gert P Westert
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2008
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-8-220

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