Quantification of standards for length-of-stay based upon optimal patient care and standard medical practice.

Length-of-stay criteria are being developed by the Allegheny Professional Standards Review Organization (APSRO) in western Pennsylvania. In order to statistically document the standard of practice at the Eye and Ear Hospital of Pittsburgh, a retrospective review of patients who underwent laryngectomy with or without radical neck dissection was performed. Results demonstrated that routinely allowing only one day preoperative assessment deviates significantly from optimal medical practice and may place some patients at increased risk, especially for postoperative complications. From a cost-effective health care delivery point of view, abbreviated preoperative preparation contributes negatively to postoperative length-of-stay which was the most costly component of hospital health care for this group of patients. The development of appropriate standards of medical practice criteria using preexisting HEW mechanisms and scientifically designed prospective studies should be encouraged.