Shorter hospital stays not linked to higher readmission rates in large VA study

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The rate of patient readmission to a hospital may not be associated with a shorter hospital stay, according to a new study. This counters the concern which led to this study, which was that excessive LOS (length of stay) reduction may be harmful because discharge before medical stability may result in increased hospital readmission or use of emergency department services.

Dr. Peter J. Kaboli, from the Iowa City Veterans Affairs (VA) Healthcare System and colleagues, analyzed more than four million patient records from 129 VA hospitals. Over the 14 year period that this study was conducted, Dr. Kaboli and colleagues found that both average LOS and relative readmission rates decreased, by 27 percent and 16 percent respectively. All cause mortality decreased as well, by 3.4 percent after 30 days and 3 percent after 90 days. However, at hospitals where average LOS was at least one day shorter than the mean LOS for all hospitals, readmission rates were actually 6 percent higher, suggesting that the specific hospital may have been too aggressive in actively trying to reduce LOS.

Authors attribute these findings to improvements in efficiency, workflow, and medication reconciliation by the VA during the period studied, as well as the adoption of a hospitalist model of care. But, Drs. Eugene Oddone and Morris Weinberger from the Center for Health Services Research in Primary Care say that thirty-day readmission rates may not be the best indicator of quality because of the complexity of factors that cause them and the poor correlation among those factors. However, they still promote the VA as a model of quality and efficiency for other American hospitals.

ACSH s Dr. Gilbert Ross had this perspective: A major goal of reducing healthcare expenditures has involved reducing LOS, and it has seemed that hospital stays have been cut down to the bone in recent years. This study provides some reassurance that patient care may not have suffered as much as some especially physicians feared it would, due to the ever-increasing pressure to discharge patients rapidly.