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Public Health Rev. 1996;24(1):37-48.

Allocation of emergency ward patients to medicine departments: increasing physicians' incentive to shorten length of stay.

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Department of Medical Management, Sheba Medical Center, Tel Hashomer, Israel.



Duration of hospital stay is one of the major determinants of hospital cost. In addition, high bed occupancy, especially in internal medicine departments, can delay the admission of patients from the emergency ward.


To shorten average hospital stay and hasten admission of patients from the emergency room to the medicine department.


Patients from the emergency ward were assigned to internal medicine departments according to a quota system that insured that each department received a similar share of these admissions. Outcome measures for the year following this administrative change were compared to the two prior years in the same hospital and to a similar public hospital during the study period.


A major public hospital.


Length of hospital stay (LOS), occupancy rate, number of admissions, number of readmissions, and mortality.


The average length of stay in the internal medicine departments was shortened from 8 +/- 8 days in 1987 and 1988 to 6.3 +/- 6.8 days in 1989 (p = 0.0001). Occupancy rate was also reduced from 94% in 1987 and 1988 to 88% in 1989 (p = 0.002). The number of admissions increased by 19.2%, with a higher rate of readmissions within 30 days of discharge from the index hospitalization (12.5% and 13.4%, respectively in 1987 and 1988, versus 16.4% in 1989, p = 0.0001). In-hospital as well as 6-month mortality were unchanged. Case mix was similar during the study period to that in the previous two years. Length of stay, occupancy rate, and number of admissions were unchanged during the same period at a similar hospital without a corresponding patient allocation system.


A relatively simple administrative intervention influenced physician incentive and significantly decreased hospital length of stay.

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