Our Stories: Improving length of stay

First, I hope you were all able to enjoy the holiday and spend time with your loved ones. For those of you who were here caring for patients, thank you so much. Thanksgiving is a time for us to reflect on the many things we are grateful for. I’ve said it before and I’ll say it again, what makes our UI Health Care team amazing is each and every one of you and what you do every day. Because of you, I’m confident we can meet any challenge, and I have great hope for our future.  

For many years, we have struggled to efficiently use our time and our patient’s time during their inpatient stay, and it’s an issue that is not unique to this organization. When we compare ourselves to other health systems across the country, we commonly refer to the Length of Stay Index (LOSI). The LOSI allows us to look at the time it takes us to care for the patient and discharge them based on the patient’s diagnosis. 

This is an area of focus for many reasons: 

  • It is a challenge drawing focus from health care organizations across the country. 
  • UI Hospitals & Clinicshas experienced sustained high patient volume year over year. 
  • Given our high census, we need open beds to provide care to the next patient who needs us, so we must also focus on an early discharge when it is safe and feasible. 

But perhaps the most important reason to focus on length of stay is that it’s the right thing to do for our patients.  If you or a loved one has ever been hospitalized you know  that waiting for discharge can be a difficult experience for the patient and their family. This waiting period is sometimes the last impression our patients have of us on the day of discharge, making it even more important that we try to make it as efficient and easy a process as possible.  

In order to provide high quality and efficient care for our patients and their families, we must: 

  • Have strong collaboration and communication across our multi-disciplinary teams 
  • Start thinking about and discussing discharge planning when the patient is admitted 
    • Think about the expected day of discharge (ask about it in huddles, and wrench it into your EPIC dashboard)  
    • Know the plan of care for the day and proactively think about the plan of care for each day until discharge 
      • What do we need to accomplish for the patient to prepare for a safe discharge? 
      • Do all members of the team know the plan and what is needed for discharge? 
  • Tell the patients and their families when we anticipate discharge and confirm it the day prior whenever possible 
  • Discuss with the patient and family the expectation of the 1100 discharge time 
    • If their ride home will be later in the day, let them know they will be sent to our discharge lounge—if they qualify—to await their ride. 
  • Engage our nurse navigators early and schedule the follow-up appointments early in the patient’s stay 
  • Engage our social workers early if the patient has potential needs for medical equipment at home, or a post-acute facility stay (SNF, rehab, etc.) 
  • Complete what you can before the day of discharge (discharge summary, patient education, consults, imaging, prescriptions, final labs, etc.) 
  • Prioritize the patients who are going home that day 
    • Physicians should first round on those patients who we anticipate going home that day and write the discharge order by 0930. 
    • Nurses should complete the discharge tasks as soon as the order is written 
  • Tell us the barriers that prevent patients from discharging  
    • Are there delays in tests/procedures being completed? 
    • Are consults pending? 
    • Do you feel empowered to escalate concerns and delays? 
    • What are the system challenges? 
      • Remember to put these into the BlindSpots portal so we can look at how these challenges may be overcome. 

We know that a patient’s status may change, and we cannot always predict when they will be healthy and able to discharge, but for those we can predict, let’s do everything we can to be ready. 

By decreasing our patient’s length of stay, not only are you helping your present inpatients, but you are improving access for patients  in our Emergency Department, operating rooms, ambulatory clinics, and outside hospitals who need our help. Lastly, when a patient is efficiently prepared for a safe discharge, you save time for yourself and your colleagues. 

Please keep your eyes open for more communication on length of stay and early discharge as we work to continue improving these processes. We look forward to continuing this journey with all of you! 

Blog contributors: 

  • Ami Gaarde, MBA, BSN, RN, OCN, Director, Nursing and Patient Care, Care Coordination (Adult) 
  • Theresa Brennan, MD, Chief Medical Officer 
  • Evelyn Kinne, MHA, Quality and Operational Improvement Engineer, Office of the Chief Medical Officer