PREDICTION OF LENGTH OF STAY IN AN INPATIENT DUAL DIAGNOSIS UNIT

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.