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Is the trend toward shorter hospital
stays good or bad for your health?
RUTH LITTMANN STAFF WRITER
Many medical professionals
say most patients heal better
at home. The food is better.
Personal attention comes
from familiar, loving faces.
But some people believe the
quest for cost-cutting has
prompted doctors and
hospitals to cut corners and
release patients prematurely.
needlessly long hospital stays when those dollars can be reallocated else-
where?" asks Dr. Lesch.
For instance, he says, doctors previously thought that patients suffering
from "bacterial endocarditis," a heart infection, required six weeks of in-
travenous antibacterial therapy in the hospital. The high cost of this treat-
ment, however, made them seek other cures.
Dr. Lesch says research led physicians to conclude that they can effec-
tively — and less expensively — treat bacterial endocarditis with four weeks
of intravenous therapy and two weeks of oral medication. In some cases, in-
travenous drugs can be administered at people's homes.
Most patients heal better at home, Dr. Lesch says. The food is better. Per-
sonal attention comes from familiar, loving faces. And there aren't as many
noxious germs floating around threatening to infect patients with yet an-
other sickness.
"Find me anyone who likes being in the hospital," Dr. Lesch challenges.
"People do better at home unless they really need the doctoring and inten-
sity of care that hospitals provide."
But he and other medical professionals note that there are drawbacks in
releasing hospitalized patients sooner rather than later. Not everyone re-
turns to a healthy home environment where family members are capable
and willing to serve as care givers. And, if a patient is sent home too gin-
gerly, the inevitable results: The patient relapses, readmittance occurs and
costs soar upward again.
The trend toward shorter stays can present other problems. Insurance
companies, in many cases, do not cover all aspects of home care. Further-
RELEASED page 54
hen Robert Reed kicked and screamed his way into the world
62 years ago, doctors told his mother to remain in her Kansas
hospital bed for a week. She couldn't return home, they warned,
for 10 days.
Ten days was the norm, but the norm wasn't necessarily
healthy, says Dr. Reed, now vice president for medical affairs
at Sinai Hospital in Detroit. Decades later, routine baby deliver-
ies require an average 1.7-day hospital stay.
"Hospitals are not good places to be in longer than you should be,"
he says. "There isn't any question that, in the past, we kept people in
the hospital longer than we needed to."
Nationwide, the trend toward shorter lengths of stay is evident. In
the 1960s, heart-attack patients were kept in the hospital for three
weeks. Today, they usually are released within seven days. Cataract
surgeries required a hospital stay until new technology enabled doc-
tors to perform the operations on an outpatient basis.
Medical professionals say several factors contribute to the trend to-
ward shorter hospital stays. New technology is one of them. Pressure
from cost-conscious insurance companies is another. Common sense,
some say, accounts for a third.
Dr. Michael Lesch, chairman of the department of internal medi-
cine at Henry Ford Hospital in Detroit, believes escalating health-
care costs have bullied the industry into reexamining old assumptions.
The price of keeping someone in the hospital ranges from $500 to
$1,000 a day. Home care can be hundreds less. "Why waste money on
HCIA Inc., an independent health care information com-
pany headquartered in Maryland, reports a general decrease
in the length ofhospital stays from 1989 to 1993. HCIA col-
lected the following data from hospitals nationwide.
1989
1993
Tonsillectomy/
Adenoidectomy
1.2 days
1.4 days
Appendectomy
4.6 days
4.0 days
Aortocoronary Bypass
Of Two Coronary Arteries
13.4 days
11.5 days
Normal Delivery
2.1 days
1.7 days
Classical Cesarean Section
6.9 days
5.8 days
Low Cervical Cesarean Section
4.6 days
3.8 days
Procedure
Averages are based exclusively on the length of stay for a principal procedure (i.e., the primary
reason an individual was admitted to the hospital). Average length of stay is calculated by divid-
ing the total number of inpatient days by the total number of patients.
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