Is length of stay for patients admitted with spontaneous subarachnoid haemorrhage an effective quality indicator?

Objectives: The aim of this study is to help better understand whether length of stay (LOS) for patients admitted with spontaneous subarachnoid haemorrhage (SAH) is an appropriate quality indicator of care for comparison of NHS Neurosurgical department performance.

Methods: We utilised Hospital Episode Statistics (HES) at a unit level to demonstrate the number of spells between 2019 and 2023 for patients presenting with spontaneous SAH as well as those that had an endovascular or microsurgical procedure to secure the aneurysm. We captured data concerning average LOS and average readmission within 30 day rates for each centre throughout the period.

Results: We demonstrated a weak relationship between shorter LOS and increased readmission rates; however, when a single outlier institutions data were removed, this relationship disappeared. The mean LOS was 25.7 days with a mean readmission rate of 4.9% for treated spontaneous SAH patients. If each centre reduced LOS to that of the shortest, there is the potential for 10,000 bed days saved per year.

Conclusions: LOS for aneurysmal SAH patients has some promise as a quality indicator of care. We support a national quality improvement project going forwards to better understand the reasons for variation in LOS and to help eliminate unnecessary variability.