Length of Stay (LOS) Deep Dive
Managing patient length of stay isn’t about pushing patients out the door as quickly as possible. It’s about providing the best, most appropriate and effective care in the optimum time, without unnecessary disruption or delay.
When caregivers are empowered to make the right clinical decisions with swift confidence, hospitals optimize length of stay to improve and sustain care quality, patient satisfaction, and capacity management.
Every unnecessary minute of a patient’s stay increases risks and affects outcomes and experience:
Increased risk of falls, infections, and other hospital acquired conditions
Reimbursement penalties for poor throughput performance
Frustration and diminished satisfaction for patients with delayed treatments and discharge
Baselines and Data Related to Hospital Length of Stay (LOS):
Average hospital LOS nationwide in 2017 was 5.7 days
Common diagnoses for inpatient stays include birth complications, acute myocardial infarction, complications of device, cardiac dysrhythmias, mood disorders, pneumonia, congestive heart failure, and osteoarthritis
Average LOS varies considerably by state, based on demographics and population distribution, with lows of 4.4 in Utah to 7.5 in Alaska and 8.8 in Wyoming
LOS Affects Care Quality, Patient Satisfaction, and Readmissions
Managing length of stay improves performance in all metrics that matter for hospitals, including care quality, patient satisfaction, and readmissions:
Patients are more satisfied and HCAHPS scores improve when they are not overwhelmed with excessive physician consultations during their inpatient stay, something that cognitive clinical guidance helps diminish. Research says “fewer inpatient consultations was the strongest predictor of patient satisfaction.”
Research shows that reduced length of stay reduces readmissions, largely due to reduced risk of infection and hospital acquired conditions. As average LOS for VA patients dropped 27 percent from 5.44 days in 1997 to 3.98 days, 30-day readmission rates also fell from 16.5 percent to 13.8 percent.
During the same time, the 30-day mortality risk from any cause decreased by 25 percent.
A five-year Emory University Hospital initiative saw an average LOS reduction of 5 days to 4.5 days correspond with in-hospital mortality drop from 2.3 to 1.1 deaths per 100 encounters.
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Length of stay significantly affects financial impact and opportunity: Average inpatient cost per day in 2015 was $2,271 and cost per stay was $11,259 Average cost per inpatient day by hospital type: State/local government hospitals: $1,974 Nonprofit hospitals: $2,346 For-profit hospitals: $1,798 Research also reveals significant economic benefits of reducing a day in length of stay for specific conditions, such as community acquired pneumonia, of about $2,300 per case
Patient throughput efficiency measures now make up 25 percent of CMS reimbursement scores. CMS penalizes hospitals that do not fall within national ranges for length of stay and cost of care for Medicare patients. The LOS measure has been added to existing quality and safety measures in the Leapfrog hospital survey. To improve access to beds, The Joint Commission (TJC) has stipulated that hospitals have processes that: Support patient flow throughout the hospital Measure available supply of beds and efficiency of patient care areas Report measurements to leadership Use data to drive improvements in patient flow processes
Promise for Improvement: The Cognitive Machine Reduces Length of Stay While Improving Outcomes
Hospitals that have adopted the Jvion Cognitive Clinical Success Machine have demonstrated significant improvement in patient throughput:
At least 50 percent reduction in work effort—intelligent clinical guidance reduces workload as well as patient care review events and actions
Estimated 10 to 30 percent reduction in excess patient days
Jvion outlier LOS outlier vector focuses review and specific clinical attention on patients who most need it
Individualized approach specific to each patient and care approach for optimum care and LOS—stay long enough for the right care, and not too long for care activities that might not advance positive outcomes
Overall Healthcare Impact
The average cost per inpatient day in all areas is $2,271. The Jvion outlier vector projects a reduction in inpatient days of 10 percent to 30 percent.
By preventing even two percent of potential excess patient days* cost savings across the nation would result in savings of $8.8 billion.
* (Total US Admissions 2016 – 35,061,292 x average U.S. length of stay of 5.5 days in 2016 = 192,837,106 total patient days * 0.2) = 3,856,742 days x $2,271 per day cost = $8.88 billion.