Better Quality Better Value – Average Length of Stay (Spells) for Geriatric
Medicine
Indicator Name
Average Length of Stay – Geriatric Medicine
Description
Sources
Reference Files
Inclusions
Exclusions
Variation in length of stay (LOS) for number of spells
SMR01
Patient Level Information & Costing System (PLICS)
Spells with a length of stay greater than zero
All specialties except Geriatric Medicine.
Location/Specialty combinations where Number of Spells < 13.
Average Length of Stay (Spells) – The ratio of actual inpatient bed days to the
expected number of bed days.
Measures
Occupied Bed Days – Number of beds which could be released per day if the
expected Mean/UQ activity was achieved.
Potential Cost Opportunity – Cost opportunities that could be made if the
Mean/UQ activity was achieved.
Numerator
Actual (observed) bed days.
Denominator
Expected bed days
Ratio
Average length of stay/Case mix adjusted average length of stay
Cost Attaching
Method
The ALOS indicator uses the PLICS delayed discharge cost to calculate potential
savings. These costs are attached onto the ALOS activity data using the following
method:
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Opportunity
Calculations
Location/Specialty cost is used if available
If unavailable, Health Board/Specialty cost is used
If unavailable, Scotland/Specialty cost is used
If no cost available, a Location/Specialty mean cost is used.
Method:
1). Calculate mean and UQ for Scotland:
 Scottish mean :- Sum(numerator)/Sum(denominator) for all of Scotland for
each Specialty and quarter.
 Scottish UQ :- Upper quartile of ratio of all Scotland for each specialty and
quarter
2). Calculate Productive Opportunity in Occupied Bed Days:
The potential bed day opportunity = the difference of the actual bed days of a
particular Hospital and the bed day performance at the same level as the Scottish
mean and upper quartile average length of stay, based on the following:
Compare to mean: (Ratio-Mean)*Denominator when (Ratio-Mean)>0
Compare to UQ: (Ratio-UQ)*Denominator when (Ratio-UQ)>0
3). Calculate Potential Cost Opportunity
Occupied Bed Days * PLICS Cost per day
Revisions
Additional Notes
The specialty of Geriatric Medicine is separated from the main length of stay
indicator due to the longer expected lengths of stay for patients admitted to this
specialty and, therefore, the productivity opportunities may be significantly higher
and may skew comparisons of the remaining specialties.
This indicator is case mix adjusted by HRG, specialty and
elective/non-elective combinations. The expected length of stay is calculated by
working out the average length of stay nationally (Scotland only) for each specialty,
elective/non-elective, and HRG combination. This is then multiplied by the total
number of episodes to get the expected length of stay. Therefore a hospital with a
value above the national average (e.g. 101% will be 1% above the national average)
and a hospital below the national average (e.g. 99% is 1% below the national
average).
Analysis is based on NHS Board of Treatment
It is possible that Potential Cost opportunities at NHS Board level may be shown for
specialties where the average length of stay ratio is better than the mean or UQ.
This is because savings are calculated at Location/specialty level and then
aggregated appropriately.