Modelling nationwide hospital length of stay: opening the black box

Hospital length of stay is considered to be a reliable and valid proxy for measuring the consumption of hospital resources. Average length of stay, however, albeit easy to quantify and calculate, does not suitably reflect the nature of such underlying distributions and may therefore mask the effects that the different streams of patients have on the system. This paper uses routinely collected and readily available nationwide data on stroke-related patients, aged 65 years and over, who were discharged from English hospitals over a 1-year period. This will be the basis for a running example illustrating the alternative methods of analysis and models of patients' length of stay. The methods include statistical methods: survival analysis, mixed exponential and phase-type distributions; and decision modelling techniques: compartmental and simulation models. The paper concludes by summarizing these various modelling techniques and by highlighting the similarity of the estimated parameters of patient flow as calculated by the phase-type distribution and compartmental modelling techniques.