Hospital length of stay, the amount of time in an episode of hospitalization from admission to discharge, is a universal and critical metric in U.S. healthcare. Most U.S. hospitals have some sort of desire to reduce length of stay as well as lower hospital readmission rates.
But despite being a metric with a simple definition, there’s a world of nuance regarding hospital length of stay (LOS) management. Some hospitals count observation lengths of stay separately from inpatient lengths of stay. Discharges may not be captured in EMRs at the true moment a patient physically leaves the hospital. Patient units with different care missions can have drastically different lengths of stay, so averaging doesn’t always make sense. Academic and community hospitals, in urban and rural settings, all have different metrics, capacities, and focuses for care. On an individual level, patient needs vary, so shorter stays aren’t always good, and longer stays are not necessarily bad. In terms of actual hospital LOS management, some critical sources only have data that’s months old, so using it to fuel improvement projects is difficult. There are many more factors to consider.
In short, no single approach covers everything relevant to determining a patient’s true or ideal LOS, and identifying the best opportunities to improve LOS, or even define what improvement means, is extremely difficult. This is not as simple as adding up some numbers and comparing averages. Googling “length of stay” produces over 25 million results. There are thousands of research articles regarding LOS improvement. Where do inpatient leaders and managers begin?
One way is by thinking about managing hospital LOS across three levels: strategic, tactical, and technical.
1. Strategic
To begin the strategic approach, identify the largest clinical variations in the hospital or hospital system that can be addressed and focus initial efforts there. Find possible clinical variations by analyzing avoidable days by patient unit, physician, and diagnosis-related group (DRG), and comparing to national norms. The Centers for Medicare and Medicaid Services’ yearly table of geometric mean length of stay (GMLOS) by DRG is the best U.S. source for understanding potential avoidable days. Also, identify patient units and physicians with variances in discharge order and actual discharge times of day. Hospital COOs, CMOs, and CNOs can decide on initial improvement projects around one or two of these areas.
2. Tactical
To effect change in LOS on a more granular level, dig into and identify micro-populations who have high opportunity for movement or discharge today. These may include patients with outstanding discharge orders to home, outpatients occupying a bed, and observation patients with no barriers to discharge (e.g., an outstanding stress test). Identifying even one or two additional patients a day for discharge can have a profound effect on LOS metrics and patient flow as a whole. Daily bed huddles, involving a combination of bed management and nursing unit management, can also drive this action.
3. Technical
The strategic and tactical levels of hospital LOS management are extremely difficult to execute without technology that assembles and analyzes data, then presents it as usable information inside a time frame tight enough to spur relevant and productive action. Hospital leaders must be able to access the data in minutes, not months, or risk losing engaged stakeholders like hospitalists. Powerful technology allows operations improvement staff to spend their time driving impactful change rather than wrangling and socializing data.
As hospitals navigate the shift to value-based care and focus on delivering cost and quality outcomes, targeted LOS reduction has become more important than ever. Undertaking these strategic, tactical, and technical steps as part of an overall performance improvement initiative, managing LOS can provide tremendous benefits for hospitals and health systems of any size.
To see how these approaches to hospital length of stay management apply in practice, view this case study showing how a leading Florida health system was able to decrease average LOS by 13 hours by deploying iQueue for Inpatient Flow technology at a strategic and tactical level.
