UK health services are under pressure to make cost savings while maintaining quality of care. Typically reducing length of time patients stay in hospital and increasing bed occupancy are advocated to achieve service efficiency. Around 800,000 women give birth in the UK each year making maternity care a high volume, high cost service. The length of stay on the postnatal ward has fallen substantially over the years but there is pressure to make still further reductions. A range of data sources were used including, national level routinely collected data, workforce planning data and data from national surveys of women’s experience. Simulation and a financial model were employed to estimate excess demand, work intensity and bed occupancy to explore the quantitative, organisational consequences of reducing the length of stay.
The study suggests that reducing the length of time women spend in hospital after birth may not generate all of the expected cost savings, if quality and access to services are maintained. Admission and discharge procedures are relatively fixed and involve high cost, trained staff time. Further more, it is important to retain a sufficient bed contingency capacity to ensure a reasonable level of service. If quality of care is maintained, staffing and bed capacity cannot be simply reduced proportionately: reducing average length of stay on a typical postnatal ward by six hours or 17% would reduce costs by just 8%. Many mothers may be content with earlier discharge, indeed surveys suggest some may welcome it. However, other mothers may leave hospital with higher levels of acuity demanding additional postnatal care in the community. Some useful savings may be realised by reducing hospital stay but these may not be as great as anticipated if care quality is to be maintained.
Bowers J, Cheyne H (2015) Reducing the length of postnatal hospital stay: implications for cost and quality of care, BMC Health Services Research, 16:16 doi: 10.1186/s12913-015-1214-4