Implications of decreasing surgical lengths of stay

Abstract

A recent study at the Prince of Wales Hospital (PoW) compared health outcomes and user satisfactionfor conventional clinical pathways with a shortened pathway incorporating day of surgery admission(DOSA), early discharge and post acute care domiciliary visits for two high volume, elective surgicalprocedures (herniorrhaphy and laparoscopic cholecystectomy). This paper quantifies cost differencesbetween the control and intervention groups for nursing salaries and wages, other ward costs, pathologyand imaging.The study verified and measured the lower resource use that accompanies a significant reduction inlength of stay (LOS). Costs of pre- and post-operative domiciliary visits were calculated and offsetagainst savings generated by the re-engineered clinical pathway. Average costs per separation were atleast $239 (herniorrhaphy) and $265 (laparoscopic cholecystectomy) lower for those on the DOSApathway with domiciliary post acute care.