Length of stay: managed care agenda or a measure of clinical efficiency?

The purpose of this paper is to provide clinicians a review of the literature on length of stay (LOS) in an effort to differentiate between superficial pressure from managed care and efficient inpatient care. We included papers that were identified through an OVID Medline search. Length of stay and psychiatry were entered as search variables. Limitations placed on the search were English language, as well as years 1990 to present. On review of the search results, all case reports and editorials were eliminated. Papers with abstracts indicating that LOS was not a primary focus of the paper were also eliminated. Lastly, one paper studying adolescent patients was eliminated to improve the homogeneity of the studies under consideration. The results and discussion are presented in a qualitative fashion, citing findings of individual studies. Effort was made to give weight to studies with large samples, good study design with explanation of any limitations or shortcomings of the individual studies, and powerful findings. What we found was that despite daily pressure upon clinicians to continually reduce LOS, the body of literature examining methods to achieve this goal without sacrificing quality, as well as the outcomes of reduced LOS, is quite sparse. As this measure affects clinical management and the doctor/patient relationship, further in depth studies are needed. It appears that the best way to fulfill the clinician's responsibilities to the patients and third party payers is through improving the services already provided to the patient.