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(Stroke. 1996;27:639-644.)
© 1996 American Heart Association, Inc.

Articles

Results of a Computerized Screening of Stroke Patients for Unjustified Hospital Stay

Robert S. Goldman, MD; Arthur J. Hartz, MD, PhD; Douglas J. Lanska, MD, MS Clare E. Guse, MS

From the Departments of Neurology and Pharmacology and Clement J. Zablocki Veterans Affairs Medical Center (R.S.G.) and the Department of Family Medicine (A.J.H., C.E.G.), Medical College of Wisconsin, Milwaukee; and the Department of Neurology, the Department of Preventive Medicine and Environmental Health, and the Sanders Brown Center on Aging, University of Kentucky Medical Center, and the Neurology Service, VA Medical Center, Lexington, Ky (D.J.L.).

Correspondence to Arthur J. Hartz, MD, PhD, Family and Community Medicine, 8701 Watertown Plank Rd, Milwaukee, WI 53226.

Background and Purpose Effective methods to monitor length of stay can help reduce unnecessary hospital stay without adversely affecting the quality of care. In this study a clinical algorithm for assessing unjustified hospital stay in stroke patients was computerized and tested.

Methods An algorithm was developed by the authors to estimate the number of medically justified and unjustified hospital days for patients admitted with a primary diagnosis of ischemic stroke. Data for the algorithm were obtained from 177 stroke patients from an acute-care teaching hospital. The performance of the algorithm was evaluated on a subset of 46 patients by comparing the number of medically unjustified hospital days determined by the algorithm with the consensus determination of two neurologists.

Results The algorithm classified 68% of the 177 patients as having some unjustified hospital days and 41% of all hospital days as unjustified. With the neurologists as the gold standard, the sensitivity of the algorithm was .89 and the specificity was .91. The correlation between the number of unjustified days determined by the algorithm and the neurologists was .76.

Conclusions There is considerable unjustified length of stay for stroke patients. Physicians can develop simple clinical algorithms for detecting unjustified hospital stay in stroke patients that provide a reasonable approximation of complex clinical judgment.

Key Words: algorithms • hospitalization • quality of health care • stroke management • utilization review

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