Length of Stay

Length of Stay

is the number of calendar days a patient stays in the hospital or facility, from admission to discharge.

Length of stay data is used in utilization management. Lengths of stay which are consistently longer than the average stay may indicate a problem with care.

Utilization management evaluates the facility’s efficiency in providing necessary services in a cost-efficient manner. The goal of UM is to eliminate under- and over-utilization of services.

UM makes decisions on the transfer of patients from acute care to a subacute or rehabilitation facility in a timely manner.

LOS data is also used in financial reports. Patients within the same DRG may be compared by LOS. Particular LOS’s for certain patients can be compared to the average length of stay (ALOS) for the DRG to identify extreme values or outliers. The reasons for
the outliers can then be explored.

Patients with the same diagnoses and procedures can be used to compare LOS by physician.

Differing LOS’s for the same patients with the same conditions may indicate differences
in medical care

Length of Stay is Calculated in the Following Manner

Same Day: Admitted and discharged on same day: 1-day length of stay.

Consecutive days: Admitted and discharged on consecutive days – Admitted June 1st
and discharged June 2nd equals 1-day length of stay.

Count the day of admission, do not count the day of discharge for the two examples above.

For lengths of stay other than the two examples above, the admission day is counted in the length of stay and the discharge day is not.
For admissions and discharges within the same month, subtract -
Admitted May 15 Discharged May 21 LOS = May 21 - May 15 = 6 days
Admitted July 10 Discharged July 30 LOS = July 30 - July 10 = 20 days

For admissions and discharges spread over two or more months, count all days but the discharge day.

Example: Admitted January 10Discharged February 2; January - 22 days Feb - 1 day =
LOS = 23 days

Discharge Days (Another Term for Length of Stay)

Discharge days are days compiled on the patient after he or she has been discharged.
This is in comparison to inpatient service days, which are compiled while the patient is
in the hospital.

Other terms for length of stay include: days of stay, inpatient days of stay, duration of inpatient hospitalization .

Notice that there is no mention of “service” in discharge days or length of stay terms.
Discharges include deaths, and the day a patient was transferred to a different facility.

Total Length of Stay

The total length of stay is the sum of the days’ stay of any group of inpatients discharged during a specified period of time.

Total length of stay may also be called discharge days.

Reasons for calculating both inpatient service days (census days) and total length of stay: Inpatient service days help in the analysis of current utilization of hospital services, a unit or a department. Length of stay can be used to analyze groups of patients with similar characteristics (diagnosis, treatment, age)

Average Length of Stay

Average length of stay is the average number of days that inpatients discharged during the period under consideration stayed in the hospital. (ALOS)

FORMULA: TOTAL LENGTH OF STAY (DISCHARGE DAYS) DIVIDED BY THE TOTAL DISCHARGES
(INCLUDING DEATHS).

The inpatient LOS is decreasing due to managed care, home health care, and increases in outpatient services.

Synonymous terms for ALOS: average duration of hospitalization and average stay

ALOS for newborns is calculated separately, due to the wide fluctuations in thenumber of days for newborn stays.

Options for computing ALOS when there is a large outlier....

For example, when there is a patient discharged who has been hospitalized over 200 or over 300 days, - a notation can be made with the ALOS explaining the effect of the outlier on the data or computation of the ALOS can be made using the median rather than the mean. The median is less sensitive to extreme values; remember, for the median to be correctly identified, all numbers must be in order.

Formula for average newborn LOS: total newborn discharge days divided by the total newborn discharges (including deaths).

Leave of Absence Days

A leave of absence is a physician-authorized absence of an inpatient from a hospital or other facility for a specified period of time occurring after admission and prior to discharge.

A leave of absence involves an overnight pass....the patient would not be present at census-taking time. Thus, a half-day visit is not considered a leave of absence.

Leave of absence days are usually computed separately when computing bed occupancy, inpatient service days, or inpatient census.

Insurance companies usually do not pay for days spent outside the hospital.

Leave of absence days ARE included in: discharge days and ALOS.

Leaves of absence can be considered a part of a patient’s treatment when the patient is expected to have a long length of stay.