Decreasing lengths of stay: the cost to the community.
BACKGROUND
Patients who are discharged earlier from hospital frequently require support from professional and unpaid carers at home after discharge. Hospitals save money per patient by discharging earlier, but it is not known whether the costs to community services and unpaid caters outweigh the savings to the hospital.


METHODS
We prospectively studied the total costs, patient satisfaction, time off work and pain scores of 224 patients who underwent elective herniorrhaphy or laparoscopic cholecystectomy and who lived locally before and after re-engineering the elective surgical service. The components of the re-engineered surgical service were a peri-operative unit, pre-admission anaesthetic assessment based on self-reported questionnaires, day of surgery admissions, enhanced patient education, clinical pathways, and post-acute care.


RESULTS
The patients treated through the re-engineered surgical service had a significantly shorter length of stay (LOS) (mean LOS: 2.2 vs 3.2 days; P < 0.001) but neither they nor their carers required more time off work. Significant determinants of time off work were smoking, heavy lifting at work and a higher pain score at day 7. Patients treated through the re-engineered surgical service recorded significantly higher satisfaction with their treatment. The cost saving to the hospital outweighed the cost of increased services provided in the community, so that the overall cost of providing treatment was over $200 less per patient through the re-engineered service.


CONCLUSIONS
This study demonstrates that changes in care provision that result in shorter LOS and greater cost effectiveness may better meet patients' needs than existing systems.
Prince of Wales Hospital and University of New South Wales, Sydney, Australia. G.Caplan@unsw.edu.au
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G
Caplan
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Board
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A
Paten
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Tazelaar-Molinia
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Crowe
S J
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Yap
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Brown
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000191:economics*; D003153:Community Health Services / Q000191:economics*; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures; D005260:Female; D006552:Hernia, Inguinal / Q000191:economics* / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D017060:Patient Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D018582:Sick Leave