Length of Stay Outliers Place Greater Strain on Hospital Resources and Costs



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By: Saparja Nag  Oct. 26, 2017

When Medicare patients are admitted into the hospital, a number of key pieces of information are submitted to the Center for Medicare and Medicaid Services including the number of days they were admitted as the length of stay. From this data, average length of stay can be calculated by primary and secondary categories as well as by diagnosis related group (DRG). Patients who stay in the hospital disproportionately longer than the average number of days are considered LOS outliers.

LOS outliers are determined from the national average by DRG as the nature of the diagnosis and presence of complications can drastically affect a patient’s length of stay. Outlier patients are considered those who stayed beyond the upper limit of the average where 15% of the discharges would be crossed. Each specific DRG can be analyzed this way in order to assess where care can made more efficient for patients. The data can be further broken down by conditions both present and not present at the time of admission, accounting for conditions that developed while in the hospital. Important terms in LOS outlier analysis are defined and explained below.  

Data Field / MetricWhat It Means
LOS OutlierPatient who stays admitted in hospital for a disproportionately longer time than the average length of stay.
Ex. For DRG 470 (Major joint replacement without comorbidities), the average LOS is 2.9 Days so a LOS outlier is considered to be any patient is the hospital for 5 or more days. For DRG 871 (Septicemia or severe sepsis w/o mv 96+ hours w mcc), the average LOS is 6.6 days so a LOS outlier is considered to be any patient in the hospital for 12 or more days.
Total Discharges in CategoryTotal discharges/hospitalizations at a hospital with a defined admission & discharge date within a clinical category
Total Days in CategoryTotal number of days all patients were admitted in hospital within a clinical category
Average LOS in CategoryAverage number of days patients stay admitted in hospital within a clinical category.
Ex. If 20 patients stay for a total of 150 days, the average LOS is 7.5 days
Total Discharges with ConditionTotal discharges/hospitalizations at a hospital with a defined admission & discharge date within DRG condition documented upon admission
Total LOS Outliers Discharges with ConditionTotal discharges/hospitalizations at a hospital with a defined admission & discharge date within DRG condition documented upon admission who have a disproportionately longer lengths of stay
% of LOS Discharges that are Outliers with ConditionPercentage of days made up by LOS outliers with DRG condition documented upon admission out of total number of days
Total Discharges without ConditionTotal discharges/hospitalizations at a hospital with a defined admission & discharge date with DRG condition not documented upon admission (or with condition that developed during hospitalization after admission)
Total LOS Outliers Discharges without ConditionTotal discharges/hospitalizations at a hospital with a defined admission & discharge date without DRG condition documented upon admission (or with condition that developed during hospitalization after admission) who have a disproportionately longer lengths of stay
% of LOS Discharges that are Outliers without ConditionPercentage of days made up by LOS outliers without DRG condition documented upon admission (or with condition that developed during hospitalization after admission) out of total number of days
LOS Outlier % Difference with and without ConditionPercentage difference in LOS outlier incidence between outliers with and without condition documented upon admission
Excess Days from LOS Outliers with ConditionTotal number of days beyond upper limit of average length of stay that LOS outlier patients stayed
Excess Days / Total DaysPercentage of excess days from LOS outliers with condition out of total days stayed by all patients

Understanding why LOS outliers exist is essential to making all healthcare more accessible and equitable. A study on metropolitan Syracuse hospitals found that 2.5% of all adult medicine patients were LOS outliers, accounting for 14,000 excess inpatient days total1. By curbing LOS outliers, hospital resources are free to be used for more acute conditions and overall cost reduction. A common means for addressing this issue is through a multidisciplinary approach within the community to address patients’ clinical and social needs2. This is a similar program type to those that have been successful in reducing super utilizer inpatient stays.

References:

  1. Belderrar A and Hazzab A. “Hierarchical Genetic Algorithm and Fuzzy Radial Basis Function Networks for Factors Influencing Hospital Length of Stay Outliers.” Healthcare Informatics Research. July 2017; 23(3): 226-232.doi: 10.4258/hir.2017.23.3.226
  2. Lagoe R et al.. “Addressing hospital length of stay outlier patients: A community wide approach.”Advances in Bioscience and Biotechnology. February 2014; 5(3): 188-196.doi:10.4236/abb.2014.53024

ABOUT THE AUTHOR

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Saparja Nag

Saparja is a healthcare journalist with a particular interest in how medicine can and should affect health policy. She has extensive experience as a health educator and research scientist in biochemistry. She also enjoys running, cooking elaborate meals, and then eating elaborate meals. Saparja received a Bachelors of Arts in Biochemistry from Vassar College.