Analysis of length of stay in a Maltese tertiary level hospital

Abstract

Purpose : The study aims to investigate the different variables affecting length of hospital stay in a Maltese tertiary level hospital, and seeks to identify any relationships between these variables. Finally, the study analyses the level of hospital performance of the said hospital under study using length of stay as a key performance indicator. Background : Length of stay is one of the key performance indicators widely used within many European countries to assess hospital efficiency. Hospitals and acute care represent the highest proportion of the healthcare expenditure (OECD, 2011) globally, and this cost is expected to remain on the rise especially with increases in ageing populations which produce and increase demands for medical services. Malta’s healthcare system is no exception to this. When considering our small size and the highly dense population within our limited resources, it is important that policy makers use evidence-based practice in healthcare to aim for optimal length of stays. Method : A mixed method approach was used for this study. A case study of the hospital under study was performed using qualitative data to gather the perspectives of all the stakeholders involved. Patient input was also included. Results were analysed using triangulation of interview data, current hospital data and standard operating procedures currently in place, to provide an in-depth insight regarding the various factors affecting hospital length of stay. The minimal mention throughout the interviews of the effect of length of stay and readmissions was the initiation of a Phase 2 study. This study used the case-control approach to analyse any effects of length of stay and readmissions on patients suffering from Chronic Obstructive Pulmonary Disease readmitted in 2013. Finally a Phase 3 study was performed to analyse the hospital performance throughout the years 2008-2013, using length of stay as a key performance indicator. Findings : The study identified a number of variables that have an effect on LOS within the acute care hospital in Malta, and study findings were in accordance with literature findings. This research highlighted that LOS is the resultant outcome of various inputs, processes and outputs, and interaction between these variables and their resultant effect on LOS was supported by this study. This study also showed the multidimensionality of the construct under study and supports the notion that LOS data should be used within the context of the total healthcare system, and unless existing frameworks and infrastructure are available, LOS data on its own is unreliable. The Phase 2 case control study on patients readmitted with COPD showed a significant correlation between the use of long-term oxygen therapy and readmission (p= 0.03). The Pabon Lasso model on hospital performance revealed that our hospital is capable of achieving a good level of performance and this many times reflects the stability within the organisation.