The Efficiency of Acute Care Bed Utilization in Newfoundland and Labrador

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Abstract
Hospital efficiency is closely related to utilization levels and length of stay. This study determined whether inappropriate bed utilization in Newfoundland was related to inefficiency or inadequate access to alternative services. It also compared Canadian Institute for Health Information (CIHI) data to our survey to determine whether they provide comparable information for monitoring efficiency. Inappropriate acute care days were identified using a modified Appropriateness Evaluation Protocol. Average length of stay (ALOS) by service for each of the province's acute care institutions was also reviewed from 1993–94 to 1995–96 using the CIHI database. Hospital admissions were inappropriate in 14.2 percent of 2,007 cases. Of the 14,194 days of care, 22.8 percent were inappropriate, with most (16.4 percent) being avoidable with better use of existing resources. Of the inappropriate days, 49.2 percent related to physicians' functions. The provincial ALOS fell from 5.70 days in 1993–94 to 5.39 days in 1995–96, but remains 10.5 percent above the national average. CIHI national data for ALOS by service correlated with the percent of inappropriate days by service (r=0.57). Excess bed utilization remains because of the inappropriate use of existing services, and almost half of the total inappropriate days in hospital could be influenced by physicians. CIHI data on LOS can be used to target services or physicians for focused intervention.