Background Length of inpatient hospital stay is a key issue in the current climate of the National Health Service. Long hospital stays are expensive and expose patients to potential iatrogenic complications.

Methods A retrospective notes review was performed of 60 inpatients attending the acute neurology ward, in order to identify the factors contributing towards length of stay, the proportion that exceed financial trim-points, and the associated financial costs.

Results Mean waiting times for MRI, multidisciplinary team meetings, transfer to rehabilitation units and district hospitals were 2, 5, 6 and 8 days respectively. The mean length of stay was 10.4 nights (SD 11.4). Twenty percent of patients exceeded their allocated trim-point. This resulted in financial penalties of £16 625 for this sample. Extrapolating these data resulted in estimated total penalties for the neurology department of £1.2 million per annum.

Conclusions/Strategies for change Issues with the coding system used to allocate financial trim-points were identified. Investment in streamlining inpatient investigations, social assessments and transfer to lower intensity care settings are required to save money in the longer term. A high proportion of neurology inpatients ‘overstay’, resulting in large financial costs, money which could potentially be saved by addressing these underlying issues.