Evaluation of a new strategy for continued stay review in hospitals.

A classification of in-patients by "reason for admission" (RFA) is described and compared with the classification by diagnosis. The RFA classification assigns length of stay on the basis of twenty-five reasons for admission for adult medical-surgical cases. Length of stay norms for the RFA method were developed and compared to diagnosis specific norms (dx norms). A group of 500 charts was subjected to simulated continued stay review using both RFA and dx norms as screening methods. Although the dx norms screened out for individual review 76% more cases than the RFA norms, the number of screened out cases in which length of stay could have been reduced without affecting the quality of care was the same. The RFA strategy may provide a more efficient method of continued stay review that is also more relevant to hospital medical care than the standard method based on diagnosis.