The institution of prospective payment systems, in which flat fees are
paid per discharge, raised the concern that hospitals might preferent
ially admit patients expected to have a short length of stay (LOS). Th
is concern presupposes that intake workers could accurately predict ps
ychiatric hospitalization LOS, but this does not appear to have been e
mpirically demonstrated. Accordingly, we examined the ability of two p
sychiatrists heading separate treatment teams on an inpatient, dual-di
agnosis unit and a program coordinator who worked with both teams to p
redict LOS for 94 patients consecutively admitted to one or the other
of these teams. Predictions were highly consistent across the raters a
nd were significantly correlated with actual LOS (r = 0.25, 0.35, and
0.45 for the three raters). However, we found that the psychiatrists w
ere accurate predictors only for patients for whom they were the atten
ding psychiatrist. The program coordinator, who was involved in the tr
eatment of all patients, was an accurate predictor for the patients of
either psychiatrist. We concluded that the relationships found betwee
n predicted and actual LOS held true only when the rater also influenc
ed treatment management and discharge. Our results do not support the
proposition that specialized intake workers independent of those provi
ding cave mould be able to predict LOS accurately.