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Alvin I. Mushlin, MD, ScM; Edgar R. Black, MD; Cynthia A. Connolly, RN; Kathleen M. Buonaccorso, RN; Shirley W. Eberly, MS

JAMA. 1991;266(1):80-83.

Abstract
Objective.
—To determine the necessary length of stay for patients admitted to the hospital with an exacerbation of chronic pulmonary disease and to compare this with the length of stay assigned by the diagnosis related group system.

Design.
—A cohort of patients were followed up prospectively after hospital admission to determine when complications, critical incidents, and the need for monitoring occurred. The medically derived necessary lengths of stay were statistically compared with the lengths of stay assigned by the diagnosis related group. Clinical factors were used to predict long vs short necessary lengths of stay.

Setting.
—Two acute care hospitals: one was the principal and the other a major community teaching hospital.

Patients.
—A consecutive sample of 83 patients who were 45 years of age or older and who required admission for treatment of chronic pulmonary disease.

Main Outcome Measures.
—The occurrence and time of complications, critical interventions, and monitoring.

Results.
—After 6 days in the hospital, 90% of patients were free of complications or the need for monitoring. However, 16 days elapsed before 90% of patients had been discharged from the hospital. The length of stay that was considered necessary for care averaged 6.9 days; the actual mean length of stay was 8.7 days. The correlation between each patient's ideal length of stay and the length of stay assigned by the diagnosis related group was low and was not statistically significant. Three clinical variables at the time of admission (high Pco₂ levels, symptoms that were present for more than 1 day, and antibiotic treatment) were associated with the need for longer hospital stays.

Conclusions.
—The medically required length of stay for patients with an exacerbation of chronic pulmonary disease was between 6 and 7 days, on average. This length of stay, which was based on clinical events, differs from the length of stay that was calculated as a statistical norm by the diagnosis related group system. Clinical characteristics may help to identify patients who require a longer length of stay.

(JAMA. 1991;266:80-83)

Author Affiliations
From the Departments of Medicine (Drs Mushlin and Black and Ms Connolly), Community and Preventive Medicine (Dr Mushlin), and Biostatistics (Ms Eberly), University of Rochester (NY) School of Medicine and Dentistry; and the Office of Clinical Practice Evaluation, Strong Memorial Hospital, Rochester, NY (Ms Buonaccorso).

Footnotes
Reprints not available.

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