Estancias medias alargadas y grupos relacionados con el diagnóstico como indicadores de eficiencia en la gestión clínica

Abstract

Objective

To evaluate the efficiency of hospital services with reference to a standard. To do this, we chose prolonged mean length of stay (LOS) of more than 30 days as the qualitative index and mean LOS per diagnosis-related group (DRG) as the standard in hospitals of the Catalan public health system.

Material and methods

We performed an observational study through retrospective evaluation of the discharges of patients hospitalized between 1/1/1999 and 31/12/2000, including exitus and transfers. Data were obtained from the minimum data set, DRGs were grouped in accordance with version 16.0 and statistical analysis was performed using the SPSS program, version 8.0. To determine statistical significance, the chi-square test was used for categorical variables and comparison of means was used for quantitative variables.

Results

One hundred ninety-eight discharges corresponding to 1.1% of total admissions were studied. The services presenting a mean LOS of more than 30 days were traumatology with 40.4%, internal medicine with 23.7% and surgery with 22.2%. The mean LOS was 44.4 days (SD = 17.2 days). The mean age was 65.8 years (SD = 18.2). The most frequent DRGs were: wound debridement and skin graft (217), major joint and limb reattachment procedures of lower extremity (209), major small and large bowel procedures with complications (148), hip and femur procedures with complications (210), and fractures of femur and pelvis (236). The most frequently associated complications were infectious and the most frequent associated diseases were heart disease in 13.3%, diabetes in 7.6% and arterial hypertension in 8.1%.

Conclusions

The service presenting the greatest LOS of more than 30 days was traumatology, especially DRGs that required a longer recovery or rehabilitation period. Because our region lacks a rehabilitation center, the mean LOS of these processes is prolonged. A statistically significant relationship was found between infectious complications and patients admitted to the traumatology service. However, no consideration was made of whether the intervention was performed on an emergency basis with poor patient preparation and greater likelihood of complications or whether the procedure was elective. No differences were found between the increase in comorbidities and the increase in LOS.