Healthcare Quarterly

Healthcare Quarterly 1(2) December 1997 : 68-68.doi:10.12927/hcq..17429
Quarterly Index

Utilization Review Key Factor in Promoting Appropriate Service


This issue of the Quarterly Index focuses on selected high volume surgical Case Mix Groups (CMG)1, based on procedures performed at most hospitals across the country. Utilization review programs often concentrate on identifying key variations in admission/discharge rates and on managing length of stay for these types of cases, with a view to promoting appropriate, high quality, and accessible health services.

Length Of Stay Comparisons

Hospital utilization management programs often focus on length of stay issues. Such programs may include measures to ensure appropriate lengths of stay to produce optimal outcomes and to reduce inappropriate services or delays, thereby freeing available resources for patients waiting for admission or access to a specific service. Variations in inpatient average length of stay (LOS) for three common surgical CMGs are shown below.

Caesarean Deliveries

A substantial portion of Canada's hospital resources are devoted to care in pregnancy and childbirth. Caesarean deliveries without complications alone account for over 120,000 inpatient days in the jurisdictions shown below. The average length of stay is 4.5 days for first caesarean deliveries and 4.0 days for repeats.

Variations In Utilization

Research in Canada and elsewhere frequently shows variation in admission and discharge rates for specific conditions. This can be attributed to numerous factors, including differences in population demographics and other characteristics, systematic variations in medical practice, support systems (whether formal or informal), inappropriate care, and other factors. Analysis of admission and discharge rates may be used to identify areas where services are over- or under-utilized.

Laparoscopic Cholecystectomy

Laparoscopic approaches are often used for cholecystectomies, particularly in larger hospitals. Laparoscopy tends to be associated with shorter post-operative lengths of stay, but this must be balanced against up-front equipment and other costs.2

The average inpatient length of stay for CMG 319 in1996/97 was 1.56 days in the provinces shown above. The rate per 100,000 population is 92.0.

Simple Appendectomies

In 1996/97, the average inpatient length of stay for a simple appendectomy without complications or co-morbid conditions was 2.8 days.


Information for the Quarterly Index provided by the Canadian Institute for Health Information (CIHI). For information about CIHI or to access the Institute's publications please consult its website at For more information regarding these statistics please contact Jennifer Zelmer at (416) 429-0464 ext. 3521 or via email at


1 Sources: Hospital utilization data are from CIHIís Discharge Abstract Database for jurisdictions reporting 100% of inpatient acute discharges for 1996/97. Population figures are drawn from Statistics Canadaís CANSIM matrix 6900 and Annual Demographic Statistics, 1996. Note: rates per 100,000 population are age/sex standardized, with the Canadian population as the standard population; rates are for the total pop., not only those under age 70.

2 CIHI. (1994). Comparative Analysis Report: Hospital Utilization in Canada, Ottawa: CIHI.

3 No CC: No complications or co-morbid conditions.


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