Study: Shorter hospital stays don't increase readmission rates
On the surface, efforts to simultaneously improve healthcare quality and efficiency may appear at odds, but research published Dec. 18 in the Annals of Internal Medicine suggest that reduced hospital lengths of stay (LOS) correlate with lower readmission rates.
“Improving efficiency by reducing LOS should benefit both patients and hospitals,” wrote lead author, Peter J. Kaboli, MD, MS, of the Iowa City Veteran Affairs Healthcare System. “Unnecessary hospital days expose patients to potential iatrogenic injury, such as infections and cost burdens. However, there is emerging concern that excessive LOS reduction may be harmful because discharge before medical stability may result in increased hospital readmission or use of emergency department services.”
To test whether there’s reason for concern, researchers examined records of approximately 4.1 million inpatient admissions to 129 hospitals within the Department of Veterans Affairs network from October 1996 to September 2010. After adjusting for differences in patient characteristics, they determined that the mean LOS decreased 1.46 days from 5.44 to 3.98 during the 14-year period. Additionally, 30-day readmission rates decreased from 16.5 percent to 13.8 percent.
Researchers concluded that, at least within the VA, reductions in mean LOS have not adversely affected the likelihood of readmissions. There are several explanations, according to Kaboli and his coauthors. Inefficiencies in care delivery could have resulted in longer than necessary LOS or a VA patient flow initiative could have had a positive impact on both readmission rates and LOS.
The high cost of hospitalizations mean the study results carry implications for policymakers and healthcare delivery systems. For instance, the study suggests that bundled payments could eliminate provider incentives for hospitalizing patients and encourage them to focus on improved efficiency instead. “With increased attention to quality of care transitions in and out of the hospital, LOS and readmissions can be simultaneously improve,” Kaboli et al concluded.