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. 2021 Sep 9;21(1):940.
doi: 10.1186/s12913-021-06972-6.

The increasing impact of length of stay "outliers" on length of stay at an urban academic hospital

Andrew H Hughes  1   2 , David Horrocks Jr  3 , Curtis Leung  3 , Melissa B Richardson  3 , Ann M Sheehy  4 , Charles F S Locke  5
Affiliations

The increasing impact of length of stay "outliers" on length of stay at an urban academic hospital

Andrew H Hughes et al. BMC Health Serv Res. .

Abstract

Background: As healthcare systems strive for efficiency, hospital "length of stay outliers" have the potential to significantly impact a hospital's overall utilization. There is a tendency to exclude such "outlier" stays in local quality improvement and data reporting due to their assumed rare occurrence and disproportionate ability to skew mean and other summary data. This study sought to assess the influence of length of stay (LOS) outliers on inpatient length of stay and hospital capacity over a 5-year period at a large urban academic medical center.

Methods: From January 2014 through December 2019, 169,645 consecutive inpatient cases were analyzed and assigned an expected LOS based on national academic center benchmarks. Cases in the top 1% of national sample LOS by diagnosis were flagged as length of stay outliers.

Results: From 2014 to 2019, mean outlier LOS increased (40.98 to 45.11 days), as did inpatient LOS with outliers excluded (5.63 to 6.19 days). Outlier cases increased both in number (from 297 to 412) and as a percent of total discharges (0.98 to 1.56%), and outlier patient days increased from 6.7 to 9.8% of total inpatient plus observation days over the study period.

Conclusions: Outlier cases utilize a disproportionate and increasing share of hospital resources and available beds. The current tendency to exclude such outlier stays in data reporting due to assumed rare occurrence may need to be revisited. Outlier stays require distinct and targeted interventions to appropriately reduce length of stay to both improve patient care and maintain hospital capacity.

Keywords: Hospital resource utilization; Length of stay; Outlier length of stay.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
LOS O/E Index Trends (Inpatient Hospitalizations)
Fig. 2
Fig. 2
Observed Mean LOS (Inpatient Hospitalizations). a. Observed Mean LOS (Inpatient Hospitalizations) with 25th and 75th percentile
Fig. 3
Fig. 3
Total Inpatient Discharges, Outlier Discharges Count and % of Total
Fig. 4
Fig. 4
Total Patient Days, Outlier Days Count and % of Total
See this image and copyright information in PMC

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