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Improving Hospital Length of Stay: Results of a Retrospective Cohort Study
(1) Background: Jersey Shore University Medical Center (JSUMC) is a 646-bed tertiary medical center located in central New Jersey. Over the past several years, development and maturation of tertiary services at JSUMC has resulted in tremendous growth, with the inpatient volume increasing by 17% betw...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234441/ https://www.ncbi.nlm.nih.gov/pubmed/34205327 http://dx.doi.org/10.3390/healthcare9060762 |
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author | Patel, Swapnil Alshami, Abbas Douedi, Steven Campbell, Natasha Hossain, Mohammad Mushtaq, Arman Tarina, Dana Sealove, Brett Kountz, David Carpenter, Kim Angelo, Ellen Buccellato, Vito Sable, Kenneth Frank, Elliot Asif, Arif |
author_facet | Patel, Swapnil Alshami, Abbas Douedi, Steven Campbell, Natasha Hossain, Mohammad Mushtaq, Arman Tarina, Dana Sealove, Brett Kountz, David Carpenter, Kim Angelo, Ellen Buccellato, Vito Sable, Kenneth Frank, Elliot Asif, Arif |
author_sort | Patel, Swapnil |
collection | PubMed |
description | (1) Background: Jersey Shore University Medical Center (JSUMC) is a 646-bed tertiary medical center located in central New Jersey. Over the past several years, development and maturation of tertiary services at JSUMC has resulted in tremendous growth, with the inpatient volume increasing by 17% between 2016 and 2018. As hospital floors functioned at maximum capacity, the medical center was frequently forced into crisis mode with substantial increases in emergency department (ED) waiting times and a paradoxical increase in-hospital length of stay (hLOS). Prolonged hLOS can contribute to worse patient outcomes and satisfaction, as well as increased medical costs. (2) Methods: A root cause analysis was conducted to identify the factors leading to delays in providing in-hospital services. Four main bottlenecks were identified by the in-hospital phase sub-committee: incomplete orders, delays in placement to rehabilitation facilities, delays due to testing (mainly imaging), and delays in entering the discharge order. Similarly, the discharge process itself was analyzed, and obstacles were identified. Specific interventions to address each obstacle were implemented. Mean CMI-adjusted hospital LOS (CMI-hLOS) was the primary outcome measure. (3) Results: After interventions, CMI-hLOS decreased from 2.99 in 2017 to 2.84 and 2.76 days in 2018 and 2019, respectively. To correct for aberrations due to the COVID pandemic, we compared June–August 2019 to June–August 2020 and found a further decrease to 2.42 days after full implementation of all interventions. We estimate that the intervention led to an absolute reduction in costs of USD 3 million in the second half of 2019 and more than USD 7 million in 2020. On the other hand, the total expenses, represented by salaries for additional staffing, were USD 2,103,274, resulting in an estimated net saving for 2020 of USD 5,400,000. (4) Conclusions: At JSUMC, hLOS was found to be a complex and costly issue. A comprehensive approach, starting with the identification of all correctable delays followed by interventions to mitigate delays, led to a significant reduction in hLOS along with significant cost savings. |
format | Online Article Text |
id | pubmed-8234441 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-82344412021-06-27 Improving Hospital Length of Stay: Results of a Retrospective Cohort Study Patel, Swapnil Alshami, Abbas Douedi, Steven Campbell, Natasha Hossain, Mohammad Mushtaq, Arman Tarina, Dana Sealove, Brett Kountz, David Carpenter, Kim Angelo, Ellen Buccellato, Vito Sable, Kenneth Frank, Elliot Asif, Arif Healthcare (Basel) Article (1) Background: Jersey Shore University Medical Center (JSUMC) is a 646-bed tertiary medical center located in central New Jersey. Over the past several years, development and maturation of tertiary services at JSUMC has resulted in tremendous growth, with the inpatient volume increasing by 17% between 2016 and 2018. As hospital floors functioned at maximum capacity, the medical center was frequently forced into crisis mode with substantial increases in emergency department (ED) waiting times and a paradoxical increase in-hospital length of stay (hLOS). Prolonged hLOS can contribute to worse patient outcomes and satisfaction, as well as increased medical costs. (2) Methods: A root cause analysis was conducted to identify the factors leading to delays in providing in-hospital services. Four main bottlenecks were identified by the in-hospital phase sub-committee: incomplete orders, delays in placement to rehabilitation facilities, delays due to testing (mainly imaging), and delays in entering the discharge order. Similarly, the discharge process itself was analyzed, and obstacles were identified. Specific interventions to address each obstacle were implemented. Mean CMI-adjusted hospital LOS (CMI-hLOS) was the primary outcome measure. (3) Results: After interventions, CMI-hLOS decreased from 2.99 in 2017 to 2.84 and 2.76 days in 2018 and 2019, respectively. To correct for aberrations due to the COVID pandemic, we compared June–August 2019 to June–August 2020 and found a further decrease to 2.42 days after full implementation of all interventions. We estimate that the intervention led to an absolute reduction in costs of USD 3 million in the second half of 2019 and more than USD 7 million in 2020. On the other hand, the total expenses, represented by salaries for additional staffing, were USD 2,103,274, resulting in an estimated net saving for 2020 of USD 5,400,000. (4) Conclusions: At JSUMC, hLOS was found to be a complex and costly issue. A comprehensive approach, starting with the identification of all correctable delays followed by interventions to mitigate delays, led to a significant reduction in hLOS along with significant cost savings. MDPI 2021-06-19 /pmc/articles/PMC8234441/ /pubmed/34205327 http://dx.doi.org/10.3390/healthcare9060762 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Patel, Swapnil Alshami, Abbas Douedi, Steven Campbell, Natasha Hossain, Mohammad Mushtaq, Arman Tarina, Dana Sealove, Brett Kountz, David Carpenter, Kim Angelo, Ellen Buccellato, Vito Sable, Kenneth Frank, Elliot Asif, Arif Improving Hospital Length of Stay: Results of a Retrospective Cohort Study |
title | Improving Hospital Length of Stay: Results of a Retrospective Cohort Study |
title_full | Improving Hospital Length of Stay: Results of a Retrospective Cohort Study |
title_fullStr | Improving Hospital Length of Stay: Results of a Retrospective Cohort Study |
title_full_unstemmed | Improving Hospital Length of Stay: Results of a Retrospective Cohort Study |
title_short | Improving Hospital Length of Stay: Results of a Retrospective Cohort Study |
title_sort | improving hospital length of stay: results of a retrospective cohort study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234441/ https://www.ncbi.nlm.nih.gov/pubmed/34205327 http://dx.doi.org/10.3390/healthcare9060762 |
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