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Published on: January 8, 2020

Do consultants differ? Inferences drawn from hospital in-patient enquiry (HIPE) discharge coding at an Irish teaching

E D Moloney1, D Smith, K Bennett

  • 1Division of Internal Medicine St James' Hospital, Dublin, Ireland.

Postgraduate Medical Journal
|May 10, 2005
PubMed

Insights

Hospital consultant specialization impacts patient length of stay, readmission rates, and resource use. General internal medicine consultants had shorter stays, while re-admissions under the same doctor increased length of stay.

Area of Science:

  • Healthcare Management
  • Clinical Outcomes Research
  • Health Informatics

Background:

  • Variations in clinical practice among hospital consultants can influence patient outcomes and resource utilization.
  • Understanding these variations is crucial for optimizing hospital efficiency and patient care.

Purpose of the Study:

  • To investigate differences in length of stay (LOS), re-admission rates, resource utilization, and diagnostic coding among hospital consultants trained in acute general medicine.
  • To analyze patient data for emergency medical admissions at St James' Hospital (SJH), Dublin.

Main Methods:

  • Retrospective analysis of 9204 hospital discharge episodes from the hospital in-patient enquiry (HIPE) system (2002-2003).
  • Categorization of consultants into four groups: gastroenterology (GI), respiratory, general internal medicine (GIM), and specialty.
  • Comparative analysis of LOS, re-admission patterns, investigation use, and diagnostic coding across consultant groups.

Main Results:

  • General internal medicine (GIM) consultants achieved the shortest LOS (median 5 days); GIM and respiratory consultants had fewer long-stay patients (>30 days).
  • Patients re-admitted under the same consultant experienced longer LOS compared to those seen by different consultants (p<0.0001).
  • Distinct patterns of diagnostic coding and investigation utilization were observed across specialties, with GI consultants more frequent in GI coding, respiratory in respiratory diagnoses, specialty in diabetes/hypertension, and GIM in heart failure.

Conclusions:

  • The hospital in-patient enquiry (HIPE) database effectively identified significant variations among consultants in LOS, re-admission rates, resource use, and disease coding.
  • Further research into the impact of protocols and guidelines on reducing these consultant-driven variations is warranted.
Abstract

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