The efficiency of inpatient medical care in a hospital secure unit

A method was developed and tested to analyze the efficiency of medical care using each patient's length of hospital stay (LOS) and comparing these LOS with patients with similar diagnoses, ages, and operative conditions. The method assigns a percentile score to each discharged patient's LOS in comparison with the group of patients in the referent population with the same medical condition. A percentile score calculated in this way removes the effect of case mix and intensity of service from each patient's LOS, and allows the efficiency of medical care to be analyzed. This method was applied to patients who were discharged from a secure unit of a general hospital that serves the tertiary medical needs of patients from the state's correctional system. The LOS for our patients on average corresponded to the 60th percentile for the LOS in other patients with comparable ages and medical conditions. This difference was significantly greater than an expected value of 50.0 (P less than 0.01). The LOS of patients discharged from each specialty service were examined. Two services were identified, in which an increased LOS represented a difference in the practice patterns of physicians in these specialties, in comparison with those of other physicians in this area. An application of the method described in this report should enable hospitals to identify units or services where patients are managed inefficiently and to guide the need for managerial intervention.