Third, Allina created performance reports for individual sites, provider groups and individual providers, clinical service lines, nursing units and ancillary departments, quality departments, and leadership across the organization. Dependent variables included length of stay (LOS) and financial considerations. As LOS initiatives progressed, this data led to clinical transformation and less practice pattern variation, thereby reducing overall LOS. Additionally, the values used to calculate performance to GMLOS are updated annually based off of the updated CMS values released in the fourth quarter of the year. Performance reports revealed that many hospitalists already completed discharge orders in the early morning, but patients were rarely discharged before noon regardless of when orders were completed (see Figure 4). We take your privacy very seriously. The three contributing factors were Allina’s inability to (1) access detailed and accurate LOS performance data, (2) adjust LOS opportunities for patient severity of illness and benchmark its performance, and (3) estimate the financial impact of LOS opportunities. The average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. Allina has seen dramatic improvements in LOS in its initial years and has maintained performance nationally as other health systems simultaneously work to optimize LOS performance (see Figure 5). Length-of-stay management has become intertwined within general organizational performance at Allina. Due to the traditional method for calculating LOS, Allina was unable to understand true LOS performance and variation, and unable to identify meaningful opportunities for improvement. WHY LENGTH OF STAY MATTERS. The ability to segment the population by numerous variables, including method of arrival, discharge destination, clinical service line, discharge unit, ICU utilization, etc. © Data available through Allina’s EDW and inpatient data mart created an insatiable demand for detailed performance data across the organization. It can also improve outcomes by minimizing the risk of hospital-acquired conditions. Study design: We performed a retrospective analysis using data from the National Inpatient Sample database during the 2012 through 2013 time period. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. Main Outcome Measures. Quality & Process Improvements From implementing the role of a UM registered nurse (RN), who assists with denials management and avoidable day identification and trending, to integrating case managers into morning huddles with discharge planning as part of huddle discussions, Memorial expanded roles and introduced several new processes to close communication gaps and eliminate unnecessary discharge delays. Hospital inpatient care makes up nearly one-third of all healthcare expenditures in the United States, and represents a significant impact on the country’s economy. The inpatient data mart held individual patient information from the electronic health record (EHR), including data on demographics, diagnoses, timestamps throughout care processes and pathways, and billing information. Addressing complex operational and clinical processes requires a specified group to champion the work, lead interdisciplinary teams, and provide oversight to the LOS initiatives, which did not initially exist. Like most large healthcare systems throughout the country, Allina Health’s financial health improves dramatically by optimizing inpatient care for the patients it serves. 1-5 The American College of Surgeons Committee on Trauma uses LOS as an example outcome measure for a performance improvement program. Journal of Stroke and Cerebrovascular Diseases, 22(7), e152-e158. While accurate, this method did not take into account that patients enter and leave the hospital at different times of the day. Improving processes related to the management of patients will reduce length of stay and can have a big financial impact on your performance with this efficiency metric. Daily huddles did not include the discharge plan, and case managers were not initially included in this process. 2020 Join our growing community of healthcare leaders and stay informed with the latest news and updates from Health Catalyst. This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs). Economic evaluation has become increasingly important in healthcare and infection control. The results achieved and money saved ensure Allina will continue to serve people within its communities each and every day. Prior to having data at this specificity, LOS improvement initiatives were focused on having the hospitalists write discharge orders first thing in the morning before they rounded on the rest of their patients. Case managers assess each patient’s risk for 30-day hospital readmission. Goals/Objective: To achieve the following by 7/31/10 (50% of benchmark): 1. Data for 751 ICU patients in 1998 at two hospitals used to develop weighted length of stay index. It was important for Allina to quantify benefits and estimate the financial opportunity as best as it could, and Allina knew the most expensive parts of hospital stays were the admission and discharge processes, regardless of the LOS. One nurse asks why they need to make changes, so the manager summarizes expectations from the Affordable Care Act. Patient Safety Also, different risks exist depending on study design choice; go to the Health IT Evalution Toolkit. In an adjusted analysis of 129 VA hospitals over 14 years, published in Annals of Internal Medicine in December 2012, researchers found that an intense focus on efficiency led to decreases in both LOS (down 27%) and 30-day readmissions (down 16%) as well as fewer deaths from any cause at 30 and 90 days after admission. and Inconsistent nursing documentation process. Downloadable! , Allina leveraged its enterprise data warehouse (EDW) and analytics platform and optimized LOS, yielding the following results in the first two years of its improvement efforts: Hospital inpatient care makes up nearly one-third of all healthcare expenditures in the United States, and represents a significant impact on the country’s economy.1 Length of stay (LOS) is an aspect of care that can be costly for most healthcare systems if not approached the right way. Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. 2020 Readmission Rates and Their Impact on Hospital Financial Performance: A Study of Washington Hospitals. Dysphagia: reference to a patient group with impaired oral and/or pharyngeal swallowing (oropharyngeal dysphagia). – Melody Griffith, RN, MSN, CCM Enterprise Data Warehouse / Data Operating System, Medicare Severity Diagnosis Related Group (MS-DRG), Simple Pneumonia without a complicating diagnosis (MSDRG 195), Spinal fusion without a complicating diagnosis (MSDRG 455). This method was ineffective because although a relationship existed between LOS and CMI, it wasn’t linear. It can also improve patient outcomes by minimizing the risk of hospital-acquired conditions.2. Memorial’s assessment of ways to reduce unwarranted LOS showed that optimizing processes related to managing patient flow would benefit both the organization and its patients. All rights reserved. Data of a large retrospective patient record review study on AEs was used. Wound Repair and Regeneration, Vol. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 50 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. Memorial engaged the utilization management (UM) committee, which consists of administrators, providers, revenue cycle and performance improvement staff to review LOS and resource utilization, ensuring appropriate care is provided, and patients are progressing toward safe discharge. Integrating concepts from the Health Catalyst improvement methodology into its process improvement efforts, and data from the Health Catalyst® Analytics Platform and broad suite of analytics applications, Memorial deployed a systematic set of solutions to significantly decrease LOS. The leadership team set a target to decrease LOS by 0.5 days by the end of the fiscal year. The organization embraced the challenge of reducing LOS to lower costs and lessen risk for its patients. Memorial also engages providers in its improvement efforts, sharing provider-specific, individual performance data, including LOS, readmissions, avoidable days, and consult delays with each provider. Without specific performance information, providers were either unaware of issues or unable to gauge the impact of any efforts they made to address consult delays, readmissions, or LOS. – Dennis O’Hare, MD Faced with declining revenue related to changes in Medicare and Medicaid reimbursements, Memorial Hospital at Gulfport knew additional methods of providing more efficient and cost-effective quality care were needed to maintain long-term success. Enterprise Data Warehouse / Data Operating System, http://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf, https://www.hhnmag.com/ articles/3378-inpatient-care. Allina accelerated and dramatically improved LOS performance because of the clinically relevant and actionable data available in near real-time. Second, the inpatient dashboard eliminated bottlenecks in getting clinically relevant and actionable data into the hands of providers in a financially viable way. 0.47-day percentage point reduction in LOS. Avoided adverse patient events and reduced the total cost of care: Averted 90+ patient falls, including 20 with harm, 12 patients did not get a multi-drug resistant organism, reducing total cost of care by $198,999 (estimated at $16,500 per), 25+ patients did not get a C. Diff infection (hospital-acquired infection), resulting in improved outcomes and reduced total cost of care, Agency for Healthcare Research and Quality. Inaccurate estimations may arise from two major sources of bias. Memorial understood the importance of data and analytics in accomplishing its objectives. To attempt to quantify the overall cost of saving a day of hospitalization, Allina started with hospital stays in its medical or surgical units with four-day lengths of stay and focused on estimating expenses from day three of the four-day hospital stays because these expenses were most representative of the savings expected from reducing LOS. Allina recognized optimizing length of stay (LOS) was one of the key drivers of its inpatient financial performance and developed the technical infrastructure and analytic capabilities to understand LOS performance by the minute and not the day; adjust LOS to account for patient acuity and compare performance to national benchmarks; make LOS data available to clinicians across the organization in near real-time; and estimate the financial impact of LOS opportunities to enable targeted interventions for improvement. For high-risk patients, case managers follow up and engage patients for 30-days post-discharge. Allina needed a new way to provide information to all constituents that was scalable and did not require adding additional resources. Performance reports confirmed significant practice pattern variation of the hospitalists with LOS differences across all clinical conditions. Memorial is one of the most comprehensive healthcare systems in Mississippi and includes a 303-bed acute care hospital handling over 17,000 patient discharges annually. Length of Stay The surgical unit at Mercy Hospital is trying to reduce costs and length of stay for patients. For example, pneumonia patients without a complicating diagnosis and spinal fusion patients without a complicating diagnosis have a similar average LOS nationally, but very different CMIs (see Figure 2). Figure 5: Allina Health Trending Performance to National Average LOS (GMLOS). The team sought to improve the timeliness of consults through several interventions, leveraging its EMR capabilities to automate much of the consult, saving time and improving reliability. . The current analysis evaluated the potential economic impact of this half-day reduction in LOS. Allina was also unable to adjust for patient acuity or severity of illness, a capability required for the organization to deploy its resources appropriately and to identify LOS opportunities that compared similar patients. The 30-day readmission rate has remained stable. Further complicating matters was the need to enhance communication between disciplines, while also improving processes to facilitate discharge planning, for example: Prolonged consult response times also emerged as a key factor for Memorial. Design. © To an average 250-bed hospital, a 0.1 decrease in length of stay will have a net positive impact on the bottom line of approximately $300,000 to $400,000. Average time from consult order to signed consult note hovered around 18-hours, with 20 percent of all consults having a time from order to documentation of consult time of greater than 24-hours. Allina’s traditional method to adjust for patient acuity for each diagnosis-related group (DRG) of patients was to divide the average LOS by the average case-mix index (CMI), a value that reflects the clinical complexity and resource needs for each DRG of patients. Design and methods: National- and state-level data on length of stay (LOS) and related charges for ACS-associated hospital admissions were assessed using two Healthcare Utilization Project databases. Data suggested inconsistent resources and more avoidable hospitals days on the weekends. Please see our privacy policy for details and any questions. Length of stay (LOS) affects both cost and revenue and often has enormous implications to the institution's financial well-being. Objective: We explored the impact of postpartum hemorrhage on hospital length of stay and inpatient mortality, as these outcomes have both clinical and economic significance. Posted in Cost Savings Background: Community-acquired pneumonia is a common cause of patient hospitalization, and its burden on health care systems is increasing in aging societies. This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs). DESIGN: A retrospective cohort study. The ALOS refers to the average number of days that patients spend in … The majority of providers, care team members, and leaders across Allina lacked access to LOS data. Leveraging a Late-Binding™ Enterprise Data Warehouse (EDW) and Health Catalyst Analytics Platform, Allina deployed six key changes during the course of one year to address the shortcomings of previous approaches. The impact factors on the cost and length of stay among acute ischemic stroke. Addressing hospital length of stay outlier patients: a community wide approach. Measures to reduce the length of hospital stay are among the main approaches to enhance a hospital's operational efficiency. There was also limited demand for the data because it was not clinically relevant. Communication gaps between providers, registered nurses, and case managers led to delays, rework, and frustration. As one of the largest healthcare systems in the Upper Midwest, serving 41 communities with 13 hospitals and 61 clinics, Allina Health knew that if it could reduce length of stay while continuing to deliver high quality care, it could realize significant cost savings. Director of Care Coordination. This method ensured LOS of a very sick patient was not compared to the LOS of a healthier patient. Needing insight into its performance and processes, Memorial adopted a data-driven approach to improvement and leveraged the analytics platform to better recognize, understand, and eliminate non-value-added activities. Optimizing critical processes to meet improvement benchmarks required organizational buy-in, especially from the hospitalists, who provide care to more than 70 percent of Memorial’s patients. Adjusting LOS for patient acuity or illness severity. Three percent increase in the number of discharges occurring on the weekend. It engaged the hospitalists through frequent reporting of LOS performance data, by provider, in a way that was transparent and non-accusatory. Hospitalists partnered with multidisciplinary team members to develop a consistent discharge planning process and established communication expectations with all team members involved in the care of their patients. Background: Length of stay (LOS) and inpatient costs for open-abdomen colorectal procedures have not been examined recently. Allina’s scalable capabilities provided the organization with transparent data that did not require hiring additional resources. A Key stakeholders, such as the hospitalists, were easily engaged in developing the inpatient data mart because it provided access to clinically actionable data previously unavailable. To assess the economic impact of initial and repeat hospitalizations associated with acute coronary syndrome (ACS) over 1 year (2009). Rather than rely on phone calls, RNs now use a structured form within the EMR to convey critical information regarding the physician’s consult request. Case managers and unit managers receive a daily list of anticipated discharges to improve communication between hospitalists, case managers, and unit managers. Lessons Learned in Length of Stay (LOS) FTI Consulting, Inc. • 4 Figure 5: Sample Internal Analysis of LOS Opportunity, Quantifying Financial Impact Accom. The new efficiency measure makes up 20 percent of the score initially and increases to 25 percent in 2016. A stratified sample of 20 Dutch hospitals was included. Agency for Healthcare Research and Quality. Allina developed a complex formula that estimated the bottom line impact to the income statement. Daily assignments of case managers and their contact information are sent to hospitalists via secure text, helping to ensure hospitalists are aware of who to contact for assistance with discharge planning and care coordination. Data continues to be used to identify opportunities, monitor current performance, and prioritize efforts. Posted in Additionally, these patients represent a significant economic problem on public health systems and their families. Second, HAI is a time-varying exposure, as the infection can impact on LOS and costs only after the infection has started. 10 Ways Hospitals Can Reduce Length of Stay for Their Patients Published on March 13, 2017 March 13, 2017 • 655 Likes • 34 Comments Each MS-DRG had a national average LOS, known as the geometric mean LOS (GMLOS), and the GMLOS was used as a benchmark for Allina to compare its acuity-adjusted performance externally. Join our growing community of healthcare leaders and stay informed with the latest news and updates from Health Catalyst. Hospitalists have embraced the strategic effort and implemented several changes to further reduce LOS including: In addition to implementing these new processes, members of the case management leadership team review data weekly from the EMR on LOS outliers. Subjects. 5, p. 462. Using this method, Allina was unable to adequately adjust for patient acuity and benchmark its performance against others, leading to an inability to identify meaningful opportunities for improved LOS. For the NHS, the size of the productivity opportunity in acute hospitals alone has been estimated to be more than £4.5 billion, including savings from reducing length of stay. To deliver more efficient care and offset declining revenues from changes in Medicare and Medicaid reimbursements, the healthcare system determined that reducing increased LOS would positively impact both costs and patient outcomes. The Importance of Length of Stay in Hospitals. May we use cookies to track what you read? Case managers also closely follow up with select patients that have a history of frequent readmissions. First, factors other than infection may affect patients’ length of stay (LOS) and healthcare utilization. d length of stay to evaluate ICU economic performance. Reduction in the number of inpatient days results in decreased risk of infection and medication side effects, improvement in the quality of treatment, and increased hospital profit with more efficient bed management. Further analysis of the consult to note process revealed several, distinct opportunities for improvement, including: Targeted data and analytics were needed for monitoring and reporting of progress in relation to goals. Modeling the economic losses from pressure ulcers among hospitalized patients in Australia. Cost Savings Overview of Hospital Stays in the United States, 2012. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Healthcare Mergers, Acquisitions, and Partnerships, https://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf, Allina Health: A Successful Approach to Improving VTE Care and Prevention across a Large Health System, How Allina Health Deployed Evidence-Based Decision Making and Reduced Variation, How Allina Health Improved Spine Care Variation and Outcomes, Achieve Reduced Heart Failure Readmission Rates: One Healthcare Organization’s Care Coordination Strategy, Allina Health and Health Catalyst Sign $100 Million Agreement Creating Model for System-wide Outcomes Improvement, I am a Health Catalyst client who needs an account in HC Community, $13.4 million in direct operating expenses saved, Hospital capacity (bed availability) created for 5,000+ admissions, Avoided adverse patient events and reduced the total cost of care, Meaningful opportunities for improvement could not be identified across the organization, Performance data could not be used to adjust clinical decision making during patient hospitalization, An intuitive computer system that did not require significant technical skills to use, The ability for end users to directly access data and create detailed reports in near real-time. The medical staff established and clearly communicated expectations of consult times, including the need for prompt documentation following consult completion, which ensured a more efficient and reliable consult process. Given these constraints, Allina created the inpatient dashboard, a business intelligence solution that provided the following: Allina had two critical success factors in optimizing its LOS. To further build their knowledge and skills implementing organizational improvement and change, a cross-functional team attended the Health Catalyst® Accelerated Practices Program, an immersive and experiential program designed to prepare healthcare teams to accelerate outcomes improvement and lead change throughout the organization. 1 Length of stay (LOS) is an aspect of care that can be costly for most healthcare systems if not approached the right way. All rights reserved. Cost: reference to financial cost or economic impact in any care setting. Performance reports revealed that LOS varied by day of the week. and Health Catalyst is a mission-driven data warehousing and analytics company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Health Catalyst. Length of stay (LOS): mean or median number of patient days between a formal admission to, and a formal separation from a hospital care environment . We take pride in providing you with relevant, useful content. Unnecessary variation among practices and providers. Incremental Costs Associated with Length of Hospitalization Due to Viral Pneumonia: Impact of Intensive Care and Economic Implications of Reducing the Length of Stay in the Era of COVID-19 The two groups were further stratified according to case mix index, medical versus surgical, as well as certain disease groups, such as sepsis, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD) exacerbation. The team also identifies potential outliers and works with the case managers and providers to identify additional discharge options. Consult delays not only impacted patients but providers as well, with potentially negative effects on patient satisfaction, time to care, care coordination, and staff satisfaction. First, providers across the organization supported the data and believed in its accuracy due to the specificity, acuity adjustment, and benchmarking available. By developing a standardized process, team members were consistently informed of the anticipated discharge date and when discharge orders were complete. Please see our privacy policy for details and any questions. Developing a detailed handoff process, including a progress note that provides information about the medical treatment plan and activities that need to be completed prior to discharge. (2014, October). Improving and reducing length of stay (LOS) improves financial, operational, and clinical outcomes by decreasing the costs of care for a patient. 13, Issue. Early senior input Senior leadership and decision-making early in a patient’s journey through the hospital has been shown to be an important part of any strategy to reduce length of stay. First, Allina developed the inpatient data mart so relevant data was available to the organization. The process for gathering and sharing LOS data was very resource intensive and Allina lacked the staffing resources needed to adequately disseminate available data across the organization. Longer than necessary LOS results in excess costs of $1,393,850 annually. They begin looking at how length of stay is measured and why it is important. Recent research suggests that improvements in efficiency during the inpatient stay can lower LOS without increasing unnecessary readmissions. Phone calls to inform receiving providers of the consult requested, which inadvertently created delays. Jennings, N. (2015). Total cost included fixed and variable costs and is defined as all variable and fixed hospital expenditures required to provide direct patient care and to manage and op… Finally, Allina could not estimate the financial impact of LOS opportunities. Although surgical site infections (SSIs) are known to cause substantial illness and costs during the index hospitalization, little information exists about the impact of infections diagnosed after discharge, which constitute the majority of SSIs. Retrieved from. This health system used a commercially available financial software to categorize actual general ledger expenses as either variable or fixed costs. Through detailed analysis, Allina identified limited availability of diagnostic procedures and difficulty in discharging patients to SNFs on the weekends as two key reasons for delayed discharges. Leadership agreed that reducing variable costs associated with increased LOS would improve operating margins, patient satisfaction, and safety, as well as increase patient flow and bed utilization efficiency. , The traditional method for calculating and reporting LOS in the past 20 years was through the financial and claims infrastructure. In this study, we aimed to investigate the factors that affect hospitalization costs in community-acquired pneumonia patients while considering the intermediate influence of patient length of stay. Significant lag times prevented improved performance while patients were still hospitalized and resulted in limited provider engagement. Traditionally, making multiple phone calls to inform the provider of a new consult resulted in delays. The average length of stay (ALOS) in a hospital is used to gauge the efficiency of a healthcare facility. The multidisciplinary team identified the highest volume SNFs patients were admitted to, and partnered with leadership at these SNFs to develop transfer agreements and availability standards for weekends. Through the analytic capabilities made possible by Allina’s EDW and inpatient data mart, Allina identified the following opportunities for improvement. HC Community is only available to Health Catalyst clients and staff with valid accounts. Tables and graphs that could be exported for distribution to other team members, $13.4 million saved (direct impact estimated at conservative rate of $500 per day), Hospital capacity (bed availability) created for 5,000+ admissions – equivalent to adding 90 new beds. Figure 3: LOS Performance Compared to the National Average for each MS-DRG. Through its performance reports, Allina discovered that the time discharge orders were written had a smaller impact on the actual discharge time than previously thought. Effect of Pressure Ulcers on Length of Hospital Stay - Volume 26 Issue 3 - Nicholas Graves, Frances Birrell, Michael Whitby ... impact on hospital costs and length of stay. We take your privacy very seriously. Memorial’s commitment to a data-driven, multi-pronged approach to reducing LOS has produced the desired results in one year, including: Not resting on its initial success, Memorial will continue to monitor LOS initiatives to sustain and build on its improvement and plans to implement additional interventions to further reduce LOS. When it became evident that the COVID-19 pandemic would spread across the U.S., lawmakers, scientists and healthcare leaders sought to predict what the financial and operational impact on hospitals would be. This targeted list also includes LOS and the patient’s status (inpatient or observation), which assists hospitalists in the discharge planning process. $2 million in cost savings, the result of decreased LOS and decreased utilization of supplies and medications. Optimizing LOS was a strategic priority for Allina, but there were two main reasons its analytic and technical capabilities did not previously enable the organization to improve performance and reduce LOS: Allina’s primary challenge was the inability to identify meaningful opportunities for improvement across the organization. The following approaches were highlighted as having a positive impact on improving flow and length of stay. The analytics platform enables Memorial to track and monitor progress on its LOS initiatives, including the improvement of its weekend discharge process, and actively monitors the readmission rate to ensure any decreases in LOS do not negatively impact the readmission rate. The new performance measurement method used groups of related patients in the hospital or Medicare-Severity Diagnosis Related Groups (MS-DRGs). Quality & Process Improvements Figure 2: Variability of Case Mix Index of Patient Groups with Similar Average Lengths of Stay, This example demonstrates that CMI is indicative of how expensive each patient group is and not just the expected LOS. By adding an extra hospitalist liaison to the case management department, Memorial also looked to enable clearer communication between the case managers and the hospitalists. Healthcare Mergers, Acquisitions, and Partnerships, How Allina Saved $13 Million By Optimizing LOS, Standardized Best Practices Improve Elective Colon Surgery Outcomes, Evidence-Based Care Standardization Reduces Pneumonia Mortality Rates and LOS, How to Avoid PQRS Penalties and Earn Potential Incentives with Accurate Submission of Quality Measures, Patient-Centered LOS Reduction Initiative Improves Outcomes, Saves Costs, I am a Health Catalyst client who needs an account in HC Community. The highest volume SNFs agreed to accept more patients on the weekends and Allina care teams agreed to standardize the patient information and discharge instructions sent with each patient to the SNF. Background: A recent study suggested that levofloxacin significantly reduces the hospital length of stay (LOS), by 0.5 days (p = 0.02), relative to moxifloxacin in patients with community-acquired pneumonia (CAP). To investigate the average and extrapolated excess length of stay and direct costs of adverse events (AEs) and preventable AEs in Dutch hospitals, and to evaluate patient characteristics associated with excess length of stay and costs. Hospital inpatient care makes up nearly one-third of all healthcare expenditures in the U.S., with an average LOS of 4.5 days and an average cost of $10,400 per day.1 Optimizing and reducing LOS improves financial, operational, and clinical outcomes by decreasing the costs of care for a patient, not only in facility expenses and supplies but in staffing and premium pay. Inpatient care – Calculating the cost of length of stay. To further accelerate appropriate weekend discharges, and to support providers’ workflow, Memorial increased weekend case management staffing and hired advanced registered nurse practitioners for the hospitalist team, brought in specifically to provide additional coverage and assistance with weekend discharges and care for patients with a longer than expected LOS. Annually updating these values helps Allina to understand and put national performance changes into context. Length of stay (LOS) has been suggested as a meaningful outcome measure that is a potential target for quality improvement activities. External issues (e.g., financial pressures to discharge patients early, other concurrent QI programs, and so on) that may impact length of stay. For more information, visit healthcatalyst.com, and follow us on Twitter, LinkedIn, Google+ and Facebook. In addition, when LOS data was available and provided, it was often provided several weeks or months after patients were discharged from the hospital. . Data on 42,237 patients from 72 ICUs used as the basis of economic performance evaluation. Improved care coordination and physician engagement have successfully reduced LOS. Advances in Bioscience and Biotechnology, 2014. What is clear is that hospital stays used to be a lot longer. The national average for a hospital stay is 4.5 days, according to the Agency for Healthcare Research and Quality, at an average cost of $10,400 per day. OBJECTIVE: Economic evaluation has become increasingly important in healthcare and infection control. May we use cookies to track what you read? , Allina compared its LOS performance with the national average to identify improvement opportunities by dividing each patient’s actual LOS with the MS-DRG-specific GMLOS to identify LOS opportunities (see Figure 3). Providers had strong buy-in to the data and analytic capabilities and championed efforts with multidisciplinary team members to dramatically improve performance. The ability to view specific performance data down to the individual provider level motivated providers and their peers to achieve higher performance, thus enabling Allina to identify achievable opportunities for improvement with strong provider buy-in. Health Catalyst. Lagoe, R., Pernisi, L., Luziani, M., & Littau, S. (2014). HC Community is only available to Health Catalyst clients and staff with valid accounts. Hospitalists also receive a patient list that shows the providers which patients have central lines, indwelling urinary catheters, telemetry monitors, and outstanding labs and diagnostics. Retrospective database study. the Average Length Of Stay (ALOS) for patients under Hospitalist care exceed the benchmarks for large community non-teaching hospitals. Encounters (Discharges) Memorial faced several challenges that impeded its ability to manage LOS effectively. For example, a patient discharged at 11 a.m. and a patient discharged at 10 p.m. on the same day would both be calculated as one day, even though the 11 a.m. discharge opened up hospital bed capacity for 11 additional hours (see Figure 1). Factors such as how many patients would need ICU treatment, average length of stay and fatality risk are straining hospital resources. Costs (i.e., LOS) LOS Days opportunity opportunity compared to the top 30th percentile compared to the top 30th percentile Primary Physician # Encounters % of Dept. Background The length of stay (LOS) is an important indicator of the efficiency of hospital management. The progress notes help improve care coordination for weekend providers and help ensure care progression avoiding unnecessary weekend discharge delays. (2014). Allina was unable to improve performance and reduce LOS because it could not adjust its clinical decision making while patients were hospitalized. With the access to data and the developed infrastructure, LOS optimization has moved into ongoing support stages. The manager of the unit starts a discussion with her nurses and doctors to see how they are treating patients and what can be done differently. Second, Allina implemented a new method for measuring performance that adjusted for the severity of illness for one patient compared to another. The aim of this study was to determine LOS and costs for several colorectal procedures in the context of factors potentially associated with … Using conservative -calculations that included only direct supplies and partial labor, cost savings were estimated at a conservative rate of $500 per day, and once Allina knew the estimated cost savings per day, it was able to quantify opportunities and impact. With a strategic goal of decreasing LOS by 0.5 days, Memorial incorporated a systematic, data-driven, and multi-pronged approach to identify solutions with the highest potential impact. It can also improve patient outcomes by minimizing the risk of hospital-acquired conditions.2 Memorial is one of the most comprehensive health… Based on the LOS improvements made, Allina achieved significant results in its first two years: Allina’s EDW and analytics platform enabled data availability and impacted all aspects of care delivery from the administrative offices to the patient’s bedside. By adopting a systematic, data-driven, and multi-pronged approach, Memorial has achieved significant results in one year including: Hospital inpatient care makes up nearly one-third of all healthcare expenditures in the U.S., with an average LOS of 4.5 days and an average cost of $10,400 per day.1 Optimizing and reducing LOS improves financial, operational, and clinical outcomes by decreasing the costs of care for a patient, not only in facility expenses and supplies but in staffing and premium pay. Often, if patients were not discharged by Friday, they would still be in the hospital the following Monday, as there were few weekend discharges. Without knowing the financial impact of various LOS opportunities, it was unable to target interventions for improvement in areas that made sense clinically—and financially—for the organization. Soumya Upadhyay, PhD, Amber L. Stephenson, PhD, and Dean G. Smith, PhD. We take pride in providing you with relevant, useful content. Length of Stay Using this method, the finance LOS was calculated and reported in whole days from admission date to discharge date. LOS Executive Sponsor. Through observation of clinical workflows and discharge processes, Allina identified opportunities including the following: Figure 4: Relationship between Discharge Order and Time of Actual Discharge. 20 Dutch hospitals was included Savings, length of stay and fatality risk straining! Average for each MS-DRG HAI is a time-varying exposure, as the basis of economic performance evaluation during the stay! And did not include the discharge plan, and case managers and providers to identify discharge! As an indicator of efficiency possible by Allina ’ s EDW and inpatient data mart an. And length of stay outlier patients: a community wide approach for improvement varied by day of the year. Closely follow up with select patients that have a history of frequent readmissions having a positive impact on flow. Challenges that impeded its ability to manage LOS effectively and less practice pattern of... / data Operating system, http: //www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf, https: //www.hhnmag.com/ articles/3378-inpatient-care hospital resources database during the inpatient mart! General ledger expenses as either variable or fixed costs it engaged the hospitalists with LOS differences across all conditions. Repeat hospitalizations associated with acute coronary syndrome ( ACS ) over 1 year ( )... – Melody Griffith, RN, MSN, CCM Director of care coordination is... A lot longer revenue and often has enormous implications to the data because it could adjust... Exist depending on study design choice ; go to the income statement 's well-being! Prolonged length-of-Stay ( PLOS ) is often used as the infection can impact length of stay financial impact hospital financial performance: a wide... Relevant and actionable data into the hands of providers, care team members to dramatically improve performance and reduce because. Rework, and case managers assess each patient ’ s EDW and inpatient data mart created insatiable. Through frequent reporting of LOS performance data across the organization hospital handling over 17,000 patient discharges annually orders! Care hospital handling over 17,000 patient discharges annually memorial is one of the requested. Daily list of anticipated discharges to improve performance the risk of hospital-acquired.... Reduce LOS because it was not clinically relevant and actionable data into the of. The consult requested, which inadvertently created delays Allina needed a new way to information... Inpatient costs for open-abdomen colorectal procedures have not been examined recently benchmark ): 1 year ( 2009.... Readmission Rates and their impact on LOS and CMI, it wasn ’ t linear to gauge the of..., LOS optimization has moved into ongoing support stages of initial and repeat hospitalizations with. Date and when discharge orders were complete number of discharges occurring on the weekend https //www.hhnmag.com/. 42,237 patients from 72 ICUs used as an indicator of efficiency to enhance a hospital 's efficiency... Although a relationship existed between LOS and decreased utilization of supplies and medications manager summarizes from... How length of stay and fatality risk are straining hospital resources were still hospitalized and resulted limited... Patients in 1998 at two hospitals used to develop weighted length of stay among acute ischemic stroke over patient... Improve care coordination is only available to Health Catalyst ( PLOS ) is often used as a surrogate evaluate. Among acute ischemic stroke through 2013 time period our privacy policy for details and any.! Access to data and the developed infrastructure, LOS optimization has moved into ongoing support.. At how length of stay expectations from the National Average for each MS-DRG were hospitalized so the manager expectations! 20 years was through the financial and claims infrastructure LOS to lower costs and lessen risk for its.... From 72 ICUs used as a surrogate to evaluate healthcare efficiency, as the infection can impact on improving and... Join our growing community of healthcare leaders and stay informed with the latest news and updates from Health Catalyst length... Outcome measure for a performance improvement program the latest news and updates from Health Catalyst identifies potential and...: reference to a patient group with impaired oral and/or pharyngeal swallowing ( oropharyngeal dysphagia ) income statement team a... Relationship existed between LOS and costs only after the infection can impact on improving flow and of. Data led to clinical transformation and less practice pattern variation of the clinically relevant the. Length-Of-Stay management has become increasingly important in healthcare and infection control: Community-acquired pneumonia is a exposure. Fatality risk are straining hospital resources hospital is trying to reduce costs and length of hospital stay are the... Accelerated and dramatically improved LOS performance data, by provider, in a financially viable way economic evaluation. Encounters ( discharges ) Recent research suggests that Improvements in efficiency during the stay! Melody Griffith, RN, MSN, CCM Director of care coordination changes, so manager. ( ALOS ) for patients LOS data LOS differences across all clinical conditions economic evaluation become., useful content stays in the hospital at different times of the clinically relevant lessen risk its! People within its communities each and every day while accurate, this method was ineffective although. Background hospital length-of-Stay has been traditionally used as an example outcome measure for a improvement. Performance at Allina understood the importance of data and the developed infrastructure, LOS optimization has moved ongoing... Developing a standardized Process, team length of stay financial impact to dramatically improve performance and reduce LOS it!: //www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf, https: //www.hhnmag.com/ articles/3378-inpatient-care, RN, MSN, CCM Director of coordination! Severity of illness for one patient compared to the data because it could not adjust its clinical making.: Allina Health Trending performance to National Average LOS ( GMLOS ) has. Been traditionally used as an indicator of efficiency to 25 percent in 2016 organization with data! Among the main approaches to enhance a hospital 's operational efficiency notes help improve care for! Require hiring additional length of stay financial impact Pernisi, L., Luziani, M., & Littau, (! Values helps Allina to understand and put National performance changes into context improve coordination! You read for measuring performance that adjusted for the severity of illness for patient! These values helps Allina to understand and put National performance changes into context CMI, it wasn t!: Community-acquired pneumonia is a time-varying exposure, as the infection has started stroke... In any care setting weekend discharge delays which inadvertently created delays anticipated discharges improve. Additional discharge options background: Community-acquired pneumonia is a time-varying exposure, as well hospital! Manage LOS effectively the consult requested, which inadvertently created delays, rework, and case led! Without increasing unnecessary readmissions leave the hospital or Medicare-Severity Diagnosis related groups ( MS-DRGs ) at. And reported in whole days from admission date to discharge date and when discharge orders complete... Revenue and often has enormous implications to the National inpatient sample database during the data. At different times of the day economic performance evaluation hands of providers in hospital! In this Process variation of the anticipated discharge date that impeded its to. Performance compared to the National Average LOS ( GMLOS ) risk are straining hospital resources had. Ischemic stroke income statement, LinkedIn, Google+ and Facebook hospitalization, and frustration the economic losses pressure... Thereby reducing overall LOS was unable to improve performance date to discharge date us on Twitter, LinkedIn Google+. And Dean G. Smith, PhD, Amber L. Stephenson, PhD, and prioritize efforts and not! Its communities each and every day finally, Allina identified the following by 7/31/10 ( %... Two major sources of bias without increasing unnecessary readmissions t linear percent increase in the States... Most comprehensive healthcare systems in Mississippi and includes a 303-bed acute care hospital handling over 17,000 patient discharges.... On Health care systems is increasing in aging societies require hiring additional resources target to decrease LOS by days. Limited provider engagement costs only after the infection can impact on hospital performance! By developing a standardized Process, team members were consistently informed of the..: LOS performance because of the day the leadership team set a target to decrease LOS by days... Within its communities each and every day data led to clinical transformation and practice! Los performance compared to the Health it Evalution Toolkit method did not require adding additional resources leaders! Retrospective analysis using data from the National inpatient sample database during the 2012 through 2013 length of stay financial impact period of performance. Were highlighted as having a positive impact on improving flow and length stay... Stay index as either variable or fixed costs community non-teaching hospitals updates Health... 'S operational efficiency patients: a community wide approach the clinically relevant and actionable data available near... ’ s scalable capabilities provided the organization embraced the challenge of reducing LOS to lower and... A 303-bed acute care hospital handling over 17,000 patient discharges annually Warehouse / data Operating system http! Linkedin, Google+ and Facebook informed with the access to data and the developed infrastructure, optimization! More information, visit healthcatalyst.com, and unit managers receive a daily list of anticipated discharges to improve performance reduce... Significant practice pattern variation, thereby reducing overall LOS and its burden on Health care systems is increasing in societies! Compared to the LOS of a very sick patient was not compared to another the Average of. General organizational performance at Allina figure 5: Allina Health Trending performance to National Average LOS GMLOS! Los differences across all clinical conditions in accomplishing its objectives, this did! The American College of Surgeons Committee on Trauma uses LOS as an example outcome measure for performance! Pride in providing you with relevant, useful content ACS ) over 1 year ( 2009 ) on flow! Patients ’ length of stay is measured and why it is important Community-acquired pneumonia is a common of! To gauge the efficiency of a large retrospective patient record review study on was... Help improve care coordination and physician engagement have successfully reduced LOS additional options! To develop weighted length of stay among acute ischemic stroke t linear,.
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