Differences in length of stay for Hospital in the Home patients: comparingsimple clinical coding with medical record review

Aim: To determine whether the apparently longer length of stay (LOS) report ed for patients with cellulitis managed in Hospital in the Home (HITH) comp ared with those managed as inpatients was correct. Methods: Data, including LOS, from the Victorian In-patient Minimum Databas e (VIMD) of all patients with cellulitis managed between July 1998 and June 1999 at a large metropolitan teaching hospital were analysed and compared with a retrospective medical record review of the same patients. Results: In the VIMD data, there were 266 episodes of cellulitis during the study period. However, the medical record review found that six episodes w ere not separate, but rather a continuation of treatment for the same episo de of cellulitis, and that 18 were not episodes of cellulitis, but were pil onidal sinus infections. In the VIMD data set, the mean LOS for patients tr eated in HITH was generally longer than that for inpatients (7.2 days vs 5. 1 days, respectively, P = 0.002). However, in the retrospective medical rec ord review, the LOS for patients treated in HITH was similar to inpatients (7.3 days versus 7.0 days, respectively, P = 0.68). Conclusions: In contrast to the VIMD data, the medical record review demons trated that, overall, patients with cellulitis had a similar LOS irrespecti ve of whether they were managed at home or in hospital. This study confirms that caution is required in interpreting the VIMD data, highlights the imp ortance of carefully monitoring the introduction of new treatment modalitie s and indicates areas for further research.