Reducing length of stay (LOS) for hospitalized patients does not increase 30-day readmission rates. LOS reduction has been an important goal for hospitals, but hospital readmission – a long-time quality metric – is a concern.
Researchers reviewed records for more than 4 million patients hospitalized at 129 acute care Veterans Affairs (VA) hospitals in the United States over 14 years to determine trends in hospital LOS, 30-day readmission rates, and 90-day mortality for all medical diagnoses combined and five specific common diagnoses (heart failure, COPD, acute myocardial infarction, community-acquired pneumonia, and gastrointestinal hemorrhage).
The researchers found that while LOS decreased by 27 percent in adjusted analysis over the 14-year time frame, the relative readmission rates did not go up, but decreased by 16 percent. At the same time, all-cause mortality at 30 and 90 days decreased by about 3 percent annually. However, hospitals that released patients earlier than expected given the severity of their illness had a higher readmission rate, with a 6 percent increase risk for each day lower than expected, suggesting some trade-off between LOS and readmission.
The authors of an accompanying editorial write that hospital readmissions is a useful metric, but it is not necessarily the best indicator of quality of care. Many factors affect readmission rates and not all factors are within the hospital’s control. As the nation’s largest accountable care organization, the VA can serve as a good example of how hospitals can improve efficiency and quality.
Associations Between Reduced Hospital Length of Stay and 30-Day Readmission Rate and Mortality: 14-Year Experience in 129 Veterans Affairs Hospitals Ann Intern Med. 18 December 2012;157(12):837-845