• length of in-hospital stay
• quality of care

The relationship between length of in-hospital stay (LOS) and quality of care is difficult. LOS is determined by a complex interweaving network of multiple supply and demand factors which operate at macro-, meso-, and micro-levels. These factors range from organisational culture and hospital bed availability, through availability of “step down” or intermediate care services, to the customs and cultures of the local populace.^1–3 On top of these many factors there is also usually an underlying downward trend in LOS for any one particular condition over time.³

In health policy terms, LOS remains an easily measurable index of “efficiency” and is quoted as such in one of the most recent publications of the UK Department of Health NHS performance indicators.⁴ In this publication the percentage “improvement” or percentage reduction in LOS compared with the previous year is plotted for each local area. The clear message from the UK Department of Health is that reductions in LOS are expected to be achieved year on year and represent “efficiency” of local health services.

Much of the literature in this area would support or certainly not refute this …