CONCURRENT UTILIZATION REVIEW AND INAPPROPRIATE HOSPITAL STAY - EVALUATION OF A PROGRAM

Using a crossover design, we tested the hypothesis that concurrent uti lization review by a utilization officer would reduce length of stay a nd inappropriate bed days in a tertiary care hospital. The interventio n groups included 396 consecutive patients admitted to specified servi ces during two 1-month study periods and followed for at least 1 month or until discharge. Controls were 410 patients admitted to the same s ervices during a preceding or subsequent month, separated by a 1-month washout period. Intervention cases had daily review of their care pla n and medical condition by the utilization officer to identify existin g or likely inappropriate hospital stay. The officer used interdiscipl inary and interdepartmental consultation in attempting to resolve iden tified problems. A separate research nurse identified the controls and gathered data on the medical condition and care plan for a random 50% sample of both intervention and control cases. These data were used b y a multidisciplinary panel to count and classify the reasons for inap propriate hospital days. Overall, there were no significant difference s between the corresponding intervention and control groups for length of stay or proportion of inappropriate days. There was evidence of a time-related reduction in both length of stay and inappropriate days o nly in the subgroup of patients with a length of stay of <15 d. As fur ther evidence of this period effect unrelated to the intervention, len gth of stay had been declining for 1 of the groups of services before this study began. We concluded that concurrent utilization review, as practiced in this study, was ineffective in the short term. However, u tilization review and modification of hospital processes can reduce in efficiency, as evidenced by the time-related reduction in inefficiency illustrated in our study.