Different consultants mean different lengths of stay in hospitals

Patients may enjoy shorter stays in hospitals depending on which consultant looks after them, according to new research published this week in Postgraduate Medical Journal.

A research team from Dublin carried out a retrospective analysis of data on discharges from the city's St James' Hospital recorded in the hospital in-patient enquiry (HIPE) system between January 1, 2002 and October 31, 2003. HIPE is a national database of coded discharge summaries from 60 acute public hospitals in Ireland.

Of the 9,204 episodes studied among 6,968 emergency medical patients admitted to the hospital through the emergency department during the study period, the median length of stay was six days overall, but 726 episodes (8%) had a stay of more than 30 days.

The type of consultant was found to make a large difference on length of stay, re-admission and resources used. Four physician groups were studied -- gastroenterology, respiratory, general internal medicine (GIM), and specialty.

The lowest length of stay -- a median five days -- was recorded in cases where a patient was admitted by a general internal medicine consultant and both GIM and respiratory consultants were less likely to have long stay patients than those of the other consultant groups.

There were also notable differences in re-admission rates -- respiratory consultants had a 41.6% readmission rate compared to the 36.9% rate for gastroenterology consultants. These were not always re-admissions for procedures.

The research argues that hospital grade physicians, when compared with specialists, can shorten length of stay and decrease inpatient costs while maintaining the quality of care.

The authors conclude: 'Variations between consultants' practice may reflect a genuine special interest bias, or absence of definitive guidelines for the management of common acute medical conditions. It would be of interest to examine the extent to which protocols and guidelines could reduce such variations.'

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