Hospital orthodoxy challenged as strategies fail to free up beds


Emergancy Entrance

Patch ’em up and get ’em out — Making hospital length of stay an efficiency metric has missed the unintended effect: unplanned readmissions. Managers at local health districts aren’t watching the rate of unplanned readmissions and the result is no increase in available beds.

In New South Wales, length of stay in hospitals is falling, while total admissions are rising. That’s a considerable success for NSW Health, says auditor-general Grant Hehir in his state hospital audit released today, but belies a 25% rate of unplanned readmissions related to deficiency of hospital care.

The department has flagged more research on the issue, and is reviewing its approach to incentivising fewer readmissions.

With increasing pressure on hospital admissions by older and chronically ill patients — a problem that Treasury’s Intergenerational Report says will only increase — the priority placed on reducing average length of stay is seeing results in NSW hospitals. However, there has been no corresponding reduction in unplanned readmissions as rapidly discharged patients find themselves returning for further treatment.

Length of stay is a KPI, highly documented at all levels and successfully reached the target specified in the NSW 2021 state plan. Unplanned readmissions is neither for local health districts, and has failed to achieve the state plan’s target. Both factors are costly. Each overnight stay for acute patients costs the health system on average $1400, Hehir notes:

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