Memorial faced several challenges that impeded its ability to manage LOS effectively. May we use cookies to track what you read? WHY LENGTH OF STAY MATTERS. 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). 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). 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. 13, Issue. Posted in Allina accelerated and dramatically improved LOS performance because of the clinically relevant and actionable data available in near real-time. Using this method, the finance LOS was calculated and reported in whole days from admission date to discharge date. 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. Director of Care Coordination. First, providers across the organization supported the data and believed in its accuracy due to the specificity, acuity adjustment, and benchmarking available. First, factors other than infection may affect patients’ length of stay (LOS) and healthcare utilization. 5, p. 462. 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. 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. We take your privacy very seriously. Adjusting LOS for patient acuity or illness severity. © 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. Allina was unable to improve performance and reduce LOS because it could not adjust its clinical decision making while patients were hospitalized. 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. Inconsistent nursing documentation process. Agency for Healthcare Research and Quality. As LOS initiatives progressed, this data led to clinical transformation and less practice pattern variation, thereby reducing overall LOS. 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. Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. The current analysis evaluated the potential economic impact of this half-day reduction in LOS. Health Catalyst. Often, if patients were not discharged by Friday, they would still be in the hospital the following Monday, as there were few weekend discharges. The new efficiency measure makes up 20 percent of the score initially and increases to 25 percent in 2016. Length of Stay 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. May we use cookies to track what you read? Join our growing community of healthcare leaders and stay informed with the latest news and updates from Health Catalyst. 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. 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. Data available through Allina’s EDW and inpatient data mart created an insatiable demand for detailed performance data across the organization. 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. The ability to segment the population by numerous variables, including method of arrival, discharge destination, clinical service line, discharge unit, ICU utilization, etc. LOS Executive Sponsor. Patient Safety Wound Repair and Regeneration, Vol. All rights reserved. Three percent increase in the number of discharges occurring on the weekend. The team also identifies potential outliers and works with the case managers and providers to identify additional discharge options. The average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. Quality & Process Improvements Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Addressing hospital length of stay outlier patients: a community wide approach. Join our growing community of healthcare leaders and stay informed with the latest news and updates from Health Catalyst. 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. External issues (e.g., financial pressures to discharge patients early, other concurrent QI programs, and so on) that may impact length of stay. Significant lag times prevented improved performance while patients were still hospitalized and resulted in limited provider engagement. Allina needed a new way to provide information to all constituents that was scalable and did not require adding additional resources. Improving and reducing length of stay (LOS) improves financial, operational, and clinical outcomes by decreasing the costs of care for a patient. With the access to data and the developed infrastructure, LOS optimization has moved into ongoing support stages. Second, the inpatient dashboard eliminated bottlenecks in getting clinically relevant and actionable data into the hands of providers in a financially viable way. 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. 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. The average length of stay (ALOS) in a hospital is used to gauge the efficiency of a healthcare facility. 1-5 The American College of Surgeons Committee on Trauma uses LOS as an example outcome measure for a performance improvement program. 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. 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. The Importance of Length of Stay in Hospitals. Unnecessary variation among practices and providers. 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. In addition, when LOS data was available and provided, it was often provided several weeks or months after patients were discharged from the hospital. Cost: reference to financial cost or economic impact in any care setting. They begin looking at how length of stay is measured and why it is important. The following approaches were highlighted as having a positive impact on improving flow and length of stay. , and What is clear is that hospital stays used to be a lot longer. Figure 5: Allina Health Trending Performance to National Average LOS (GMLOS). This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs). The ALOS refers to the average number of days that patients spend in … 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. (2014, October). It engaged the hospitalists through frequent reporting of LOS performance data, by provider, in a way that was transparent and non-accusatory. 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. and Data suggested inconsistent resources and more avoidable hospitals days on the weekends. 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 Average Length Of Stay (ALOS) for patients under Hospitalist care exceed the benchmarks for large community non-teaching hospitals. Data continues to be used to identify opportunities, monitor current performance, and prioritize efforts. 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. . Design. 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. This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs). 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. , 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. 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. Subjects. Length of stay (LOS) has been suggested as a meaningful outcome measure that is a potential target for quality improvement activities. Main Outcome Measures. 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. Cost Savings Please see our privacy policy for details and any questions. Length-of-stay management has become intertwined within general organizational performance at Allina. 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. 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. 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). 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. DESIGN: A retrospective cohort study. The traditional method for calculating and reporting LOS in the past 20 years was through the financial and claims infrastructure. 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. 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. Memorial understood the importance of data and analytics in accomplishing its objectives. 10 Ways Hospitals Can Reduce Length of Stay for Their Patients Published on March 13, 2017 March 13, 2017 • 655 Likes • 34 Comments The results achieved and money saved ensure Allina will continue to serve people within its communities each and every day. Cost Savings Goals/Objective: To achieve the following by 7/31/10 (50% of benchmark): 1. 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. Encounters (Discharges) Retrospective database study. – Melody Griffith, RN, MSN, CCM There was also limited demand for the data because it was not clinically relevant. 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. 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. 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. Also, different risks exist depending on study design choice; go to the Health IT Evalution Toolkit. Communication gaps between providers, registered nurses, and case managers led to delays, rework, and frustration. 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. 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. Case managers assess each patient’s risk for 30-day hospital readmission. 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… 2020 The majority of providers, care team members, and leaders across Allina lacked access to LOS data. The 30-day readmission rate has remained stable. 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. 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. 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. 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. $2 million in cost savings, the result of decreased LOS and decreased utilization of supplies and medications. A stratified sample of 20 Dutch hospitals was included. This health system used a commercially available financial software to categorize actual general ledger expenses as either variable or fixed costs. 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. 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. Soumya Upadhyay, PhD, Amber L. Stephenson, PhD, and Dean G. Smith, PhD. The impact factors on the cost and length of stay among acute ischemic stroke. This method was ineffective because although a relationship existed between LOS and CMI, it wasn’t linear. 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. Longer than necessary LOS results in excess costs of $1,393,850 annually. Case managers and unit managers receive a daily list of anticipated discharges to improve communication between hospitalists, case managers, and unit managers. 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). Lessons Learned in Length of Stay (LOS) FTI Consulting, Inc. • 4 Figure 5: Sample Internal Analysis of LOS Opportunity, Quantifying Financial Impact Accom. Finally, Allina could not estimate the financial impact of LOS opportunities. 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. HC Community is only available to Health Catalyst clients and staff with valid accounts. Inaccurate estimations may arise from two major sources of bias. Second, HAI is a time-varying exposure, as the infection can impact on LOS and costs only after the infection has started. It can also improve patient outcomes by minimizing the risk of hospital-acquired conditions.2. 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. By developing a standardized process, team members were consistently informed of the anticipated discharge date and when discharge orders were complete. 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. Data of a large retrospective patient record review study on AEs was used. Health Catalyst. 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. 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. OBJECTIVE: Economic evaluation has become increasingly important in healthcare and infection control. 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. Background: Length of stay (LOS) and inpatient costs for open-abdomen colorectal procedures have not been examined recently. 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). Additionally, these patients represent a significant economic problem on public health systems and their families. . 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. Economic evaluation has become increasingly important in healthcare and infection control. – Dennis O’Hare, MD 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. Inpatient care – Calculating the cost of length of stay. While accurate, this method did not take into account that patients enter and leave the hospital at different times of the day. The new performance measurement method used groups of related patients in the hospital or Medicare-Severity Diagnosis Related Groups (MS-DRGs). Data on 42,237 patients from 72 ICUs used as the basis of economic performance evaluation. All rights reserved. Please see our privacy policy for details and any questions. Posted in 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. 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. This method ensured LOS of a very sick patient was not compared to the LOS of a healthier patient. 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. 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. Dependent variables included length of stay (LOS) and financial considerations. Downloadable! For more information, visit healthcatalyst.com, and follow us on Twitter, LinkedIn, Google+ and Facebook. 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). 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. 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. 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 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). 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. Performance reports revealed that LOS varied by day of the week. Modeling the economic losses from pressure ulcers among hospitalized patients in Australia. Recent research suggests that improvements in efficiency during the inpatient stay can lower LOS without increasing unnecessary readmissions. Daily huddles did not include the discharge plan, and case managers were not initially included in this process. Through the analytic capabilities made possible by Allina’s EDW and inpatient data mart, Allina identified the following opportunities for improvement. 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. The aim of this study was to determine LOS and costs for several colorectal procedures in the context of factors potentially associated with … Improved care coordination and physician engagement have successfully reduced LOS. It can also improve patient outcomes by minimizing the risk of hospital-acquired conditions.2 Memorial is one of the most comprehensive health… Advances in Bioscience and Biotechnology, 2014. Dysphagia: reference to a patient group with impaired oral and/or pharyngeal swallowing (oropharyngeal dysphagia). Figure 3: LOS Performance Compared to the National Average for each MS-DRG. Jennings, N. (2015). © We take pride in providing you with relevant, useful content.