Improving length of stay on a trauma service

BACKGROUND: Reducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized patient management would lead to decreased LOS. METHODS: Retrospective analysis of Trauma Registry data compared LOS before (PRE) and after (POST) implementation of standardized processes on a trauma service. Patients were subdivided by age (over and under 65 years). Data were compared using unpaired t-test, χ(2) test and analysis of variance tests, where appropriate. RESULTS: 1613 PRE and 1590 POST patients were compared. Although age and Injury Severity Score were similar, median LOS decreased by 1 day for the group overall (p<0.0001), and for subgroups over and under the age of 65 years (p<0.0001). Older patients were discharged home 13% more often in POST, compared with 4% more for younger patients. CONCLUSIONS: Improved standardization of processes on a trauma service reduced LOS in patients of all ages. A prospective study may identify specific factors associated with prolonged LOS, to allow further improvement. LEVEL OF EVIDENCE: III. STUDY TYPE: Therapeutic/Care management.