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The Long and Short of It
An effort to reduce length of stay is underway throughout Hopkins Hospital, and so far, the results have been remarkable

Shorter hospital stays are not only cost effective, they are also linked to greater patient satisfaction and improved access to care. For these reasons, The Johns Hopkins Hospital has mounted an aggressive campaign to reduce length of stay. It is an ongoing effort that has met with early success.

Last fall, under Director of Medicine Mike Weisfeldt, leaders from Medicine, Surgery, Neurosciences, Psychiatry and Oncology came together to look at how length of stay (LOS) could be reduced throughout the hospital. To gather the necessary data, the group turned to John Behzad, the Health System’s director of business process improvement.

Behzad sliced and diced the information according to needs. His reports compared current LOS performance to previous periods. Using a national benchmark, they measured Hopkins’ LOS against that of the country’s most efficient hospitals. With everything adjusted for case mix and severity, they compared LOS among similar cases but with different physicians. “Because everything is data-based, these reports are credible tools for measuring performance,” says Behzad, also interim administrator of Physical Medicine and Rehabilitation.

Next, the group set about preparing action plans. Delays in diagnostic tests and consultative work were reduced; social workers and caseworkers began post-discharge planning early on; clinicians focused on proven best practices. “For a given diagnosis, such as hydrocephalus, we came up with an appropriate length of stay and stuck to it,” says Daniele Rigamonti, a neurosurgeon and member of the Length of Stay Reduction Committee. “We made sure we were properly coding the severity of cases so that our predicted lengths of stay were appropriate.”

The committee’s goal was to reduce average LOS by 2/10 of a day by December 2003. Remarkably, that goal was accomplished by June 2003. In Medicine, LOS was 9 percent lower than the previous year. In Ob/Gyn, it was 7 percent lower; Neuroscience, 6 percent; and Surgery, 4 percent.

There’s a point at which LOS levels off. “You’re always trying to maintain equilibrium between length of stay and the time it takes to do something best. It’s like walking a tightrope,” says Rigamonti. “A test may be developed that will be more sensitive and actually prolong length of stay. But the outcome will be improved, and the overall cost to society will be less.”

- Anne Bennett Swingle


 

 

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