title: Specialty-specific admission: a cost-effective intervention?
abstract: BACKGROUND
  Cost effectiveness of healthcare has become an important component in its delivery. Current practices need to be assessed and measured for variations that may lead to financial savings. Speciality specific admission is known not only to lead improved clinical outcomes but also to lead important cost reductions.
  
  
  METHODS
  All patients admitted to an Irish teaching hospital via the emergency department over a 2-year period with a gastroenterology (GI) related illness were included in this analysis.GI illness was classified using the Disease related grouping (DRG) system. Mean length of stay (LOS) and patient level costing (PLC) were calculated. Differences between DRGs with respect to speciality (i.e. specialist vs. non-specialist) were calculated for the five commonest DRGs.
  
  
  RESULTS
  Significant variations in LOS and PLC were demonstrated in the DRGs. Mean LOS varied with increasing complexity, from 3.2 days for non-complex GI haemorrhage to 14.4 days for complex alcohol related cirrhosis as expected. A substantial difference in LOS within DRG groups was demonstrated by large standard deviations in the mean (up to 8.1 days in some groups) and was independent of complexity of cases. PLC also varied widely in both complex and non-complex cases with standard deviations of up to <euro>17,342 noted. Specialty-specific admission was associated with shorter LOS for most GI admissions.
  
  
  CONCLUSIONS
  Significant disparity exists for both LOS and PLC for most GI diagnoses. Specialty-specific admissions are associated with reduced LOS. Specialty-specific admission would appear to be cost-effective which may also lead to improved clinical outcomes.
authors.affiliation: Department of Gastroenterology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. Slattery.eoin@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Slattery
authors.forename: G C
authors.initials: GC
authors.lastname: Harewood
mesh_terms: D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000191:economics; D004066:Digestive System Diseases / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D013038:Specialization / Q000191:economics* / Q000706:statistics & numerical data