Editorials

Length of hospital stay after hip fracture

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h823 (Published 24 February 2015) Cite this as: BMJ 2015;350:h823
  1. Peter Cram, professor of medicine,
  2. Raphael Philip Rush, medical resident
  1. 1Department of Medicine, University of Toronto, Toronto, ON, Canada
  1. peter.cram{at}uhn.ca

How low can we go before patients are at risk?

The modern healthcare system is a victim of its own success. The number of elderly people globally is higher than at any point in history in both relative and absolute terms. As populations age, their care needs increase. Healthcare costs have increased commensurately.

Acute care hospitals play an outsized role in health system economics. They deliver life saving treatments at enormous cost. The inpatient setting has therefore become an obvious target for efforts to improve efficiency and reduce costs.

One way to reduce costs is to reduce bed capacity, moving patients more rapidly through the hospital by reducing length of stay. Different nations have used different strategies to reduce length of hospital stay. Some have used regulation and policy to reduce the number of inpatient beds, restricting supply of beds, and forcing hospitals and healthcare professionals to reduce length of stay to accommodate patient demand. Other nations have used incentives such as diagnosis related group (DRG) based hospital reimbursement, in which hospitals receive a lump sum payment for an admission regardless of length of stay or resources consumed.1 Under this model, hospitals face strong financial incentives to reduce length …

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