Strategies for Reducing Length of Stay

Dr Imran Waheed19th August 2010

Introduction

Patients - Recovery is impeded, future resilience lower

Fiscal - reducing LoS by 1 week for just 100 patients a year would result in £150,000 saving – if you do that for 1000 patients you save £1.5 million

Future Strategies

“Problems cannot be solved by the same level of thinking that created them”

Albert Einstein

Ten Strategies for Reducing Length of Stay

(1) Robust Data/Analysis

Use robust scientific data to analyse LoS, peak times for admissions, peaks and troughs of bed occupancy

Clinicians need to have access to this data on a real time basis

(2) Eradicate Treatment Delays More efficient admission procedures –

patients must arrive with treatment plans and treatment charts; speedy and judicious use of medication

Expected discharge dates on admission

(3) Ward Reviews

Daily ward reviews – counter intuitive that we admit 7 days a week and discharge once a week.

Need to deal with the resistance to change that exists on some inpatient wards

(4) 10 am Discharge Policy All patients identified for discharge must

be ready to go by 10 am Medication ordered Transport arranged Beds available for admissions in the day

– avoids overspill into “out of hours” Accommodate patients in day

rooms/areas once waiting for discharge

(5) Using Technology

Real time bed status/LoS information – use of electronic whiteboards

eCRS - computers and projector/electronic whiteboard in ward review – patient records immediately available, entries made in notes at the time of the ward review

(6) Out of Hours

We admit 7 days a week and discharge 5 days a week

Senior medics are present for about 220 days out of 365 days in a year

Evening ward reviews at hubs Saturday ward reviews by consultants to

identify possible discharges Aim for all patients to be seen within 24

hours by a senior medic

(7) Interface

We need to work on the “pulling” mechanism

CMHTs need to pass people back to primary care

AOT passing patients back to CMHT Regular (lunch) meetings between

inpatient, CRHT, CMHT and AOT.

(8) Widen the net

The focus should not only be on “delayed discharges” but we should seek to reduce the LoS for all patients

Majority of inpatients are not “delayed discharges” – modest improvements will have a significant impact

(9) Bed Management

Need more medical input in bed management

There is an argument for decentralisation of bed management and giving clinicians greater responsibility for beds.

(10) Triage ward

Consider setting up a short stay triage ward that directs patients to inpatient ward, home treatment or CMHT

In Lewisham (SLAM) this led to 42% of admissions to the triage ward being discharged in 7 days

Strategies for Reducing Length of Stay

Thank you...Any Questions?