[Length of hospital stay, discharge planning, and policy regarding the shortening of hospital stays: patients'and hospital care providers'point of view].
BACKGROUND
In the context of health care cost containment, we interviewed hospitalized patients and their health care teams concerning the length of stay they considered necessary and hospital discharge. Patients were also interviewed on the present tendency to shorten hospital stays.


METHODS
Prospective study conducted in a subacute internal medicine ward with 254 consecutive patients and their health care teams.


RESULTS
The mean evaluation of the length of stay considered as necessary was not significantly different between patients (9.7 days, SD=9.5) and their health care teams (9.6, SD=8.5). However, agreement between the two parties was moderate (r=0.64). Hospital discharge was considered as planned in similar proportions (18% vs 22% respectively), but was reported as more 'assured' by health care teams than by patients (p<0.001). Health care teams and patients approved discharge planning in 200 cases (63.3%), but agreement was only moderate (Kappa 0.43, IC 95%=0.34-0.51). Regarding the tendency to shorten hospital stays, patients'responses were favorable in only 9%, clearly unfavorable in 17% and disclosed explicit fears in 54% of the cases.


CONCLUSIONS
These results show that what patients and health care teams consider the necessary length of stay and the right time for hospital discharge can diverge notably. They highlight the difficulties of medical decisions in the context of cost containment, and the fundamentally asymmetrical character of the relationship between patients and health care teams.
Luthy
C
C
Service de Médecine Interne de Réhabilitation, Département de Médecine Interne, Hôpitaux Universitaires de Genève, CH-1211 Genève 14, Suisse. christophe.luthy@hcuge.ch
Rentsch
D
D
Cedraschi
C
C
Sigaud
P
P
Perneger
T-V
TV
Allaz
A-F
AF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003363:Cost Control / Q000191:economics; D005069:Evaluation Studies as Topic; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine; D007407:Interviews as Topic; D007902:Length of Stay / Q000191:economics / Q000331:legislation & jurisprudence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics; D010358:Patient Participation; D011446:Prospective Studies; D011634:Public Health; D013557:Switzerland