PATIENT CARE EVALUATION COLON/RECTAL CANCER PATIENT LENGTH OF STAY DATA YEARS: 2000, 2001
REVIEWING PHYSICIAN: MARK AUNG, MD
DATA COLLECTOR: LOREN HUDSON, BA, CTR
PROPOSAL:
A recent review of Del Sol Medical Center patients who were diagnosed with cancers of the colon and rectum revealed that patients seen for initial diagnosis and treatment at this facility are spending an average of thirteen (13) days in the hospital. The average DRG (diagnosis related group) length of stay assigned to these patients is nine (9) days. This study is proposed to determine admission patterns and identify data connected to hospital length of stay for these patients.
PURPOSE:
Data Items Collected and Compared in This Study Include:
ELIGIBILITY:
Patients entered into this study will be individuals admitted to the hospital for initial diagnosis and treatment of primary cancers of the colon and rectum that meet the following criteria:
1. Patients must have a histologically confirmed primary cancer of the colon or rectum classified as malignant that was initially diagnosed at Del Sol Medical Center.
2. Patients must have initial malignant disease diagnosed and treated at Del Sol Medical Center between January 1, 2000 and December 31, 2001.
FINDINGS: Total Hospital Admissions Reviewed: 61
Most Common DRG's for Study Patients:
DRG 148 - small & large bowel procedures with complications
DRG 149 - small & large bowel procedures without complications
(These two DRG's account for 74% (45) of the total study patients.)
Average Patient Length of Stay for DRG's 148, 149: 13 days
Average DRG Assigned Length of Stay for DRG's 148, 149: 9 days
Total Patients Admitted Through the Emergency Room: 32 (53%)
Total Patients Admitted to DSMC Directly by a Physician: 29 (47%)
Upon discharge from any hospital patients are assigned a DRG (diagnosis related group) code. By grouping patients with similar diagnosis, treatment and procedures various departments throughout the hospital can access and review important patient, treatment and reimbursement related information. The most common DRG's assigned to this study's patients are 148 and 149, as stated above. These two DRG groups account for 74% of the total study subjects. According to Length of Stay Benchmarks, Southern/National, Ingenix, Reden & Anders Ltd., 2002, (pgs. 165, 166) the national and southern region average length of stay for these DRG groups is nine (9) days. This indicates that this study's patients are spending an average of five (5) days longer in the hospital than patients in the national and southern region averages (see Graphs 1, 2, 3, & 4.)
A review of patients admitted through the emergency room reveals that 34% spent less than 10 days in the hospital. Sixty-six percent of these patients had a hospital length of stay of 11 or more days (see Graphs 5, 6 & 7.)
A review of patients admitted directly by their physician reveals that 55% spent less than 10 days in the hospital. Forty-five percent of these patients had a hospital length of stay of 11 days or more (see Graphs 5, 6 & 7.)
Patients admitted through the emergency room spent more days in the hospital before surgery. Sixty-two percent of these patients spent more than three days prior to surgery, and 43% spent more than five days in the hospital before surgery (see Graphs 5, 6 & 7.)
Thirty-eight percent (11 patients) of direct admissions were taken directly to surgery. While only 13% (4 patients) of emergency room admissions were taken directly to surgery. Of the patients classified as direct admissions, only 34% spent 3 or more days in the hospital before surgery (see Graphs 5, 6 & 7).
The most common diagnoses for patients admitted through the emergency room were anemia (93%), abdominal pain, abdominal distention, and nausea & vomiting. Twenty-two (69%) of these patients had not consulted a physician for their symptoms prior to admission. (see Graphs 8 & 9.)
The most common diagnoses for patients not admitted through the emergency room were anemia (67%), rectal bleeding, abdominal pain and constipation or diarrhea. All 29 (100%) of these patients had consulted a physician for symptoms prior to hospital admission. (see Graphs 10 & 11)
FINAL CONCLUSION:
In a breakdown of study patient length of stay by DRG, the data indicates that DRG groups 148 and 149 spent an average of five (5) more days in the hospital than the national and southern region patients. (Length of Stay Benchmarks, Southern/National, Ingenix, Reden & Anders Ltd., 2002, pgs. 165, 166)
While emergency room and non-emergency room admissions are essentially equal at 47% and 53% respectively. Patients admitted through the emergency room spent more days in the hospital prior to surgery than those patients not admitted through the emergency room (see Graphs 5, 6 & 7).
A large percentage of patients admitted through the emergency room had not consulted a physician for their symptoms. This indicates a strong need for colon/rectal cancer awareness and education in the El Paso community.
RECOMMENDATIONS:
Provide a copy the study's data findings to the DSMC Case Management department for further evaluation. After a review by Case Management, their findings and recommendations, if any, will then be forwarded to all other affected hospital departments. The Case Management Department will be asked to report their findings to the Cancer Committee by June 2003.
Increase the DSMC Cancer Program's participation in colon/rectal cancer awareness month activities in 2003 (specifics to be determined by the Cancer Committee).
Submit a proposal to the DSMC Cancer Committee to determine the possibility of a colon/rectal cancer screening in either 2003 or 2004.