While reimbursement requirements are a major driver of this focus, reducing LOS can also decrease the number of hospital-acquired conditions (HACs), which are subject to payment reductions of their own. Efforts to reduce LOS have led to a flurry of research into factors that impact LOS and how to address them. Due to the diversity of patient conditions, however, much of the literature tends to rightfully focus on a very specific class of patient (e.g., patients with acute kidney damage). However, there are also several general operational factors that have an impact on LOS and are more straightforward to address.
Large Prize: Since patient access is inversely proportional to LOS, the impact of even an incremental change in LOS can be quite significant. For example, if a 300-bed hospital with an average LOS of four days was able to reduce the average LOS by five percent (i.e., by five hours), they could treat over 1,350 more patients each year. That's a considerable increase in patient access and millions of dollars in additional income from the same fixed capacity. In addition, addressing these issues also typically improves the patient and provider experience; it leads to reduced wait times in the emergency department (ED), fewer issues with boarding, quicker discharge, and an overall "saner" experience for everyone involved.
I have identified 10 factors that, if addressed with precision and the right data and predictive analytics, can reduce LOS:
Incorrectly assessing the required size of a unit leads to a higher percentage of patients not being placed into their target unit, longer wait times to get patients out of the ED and more complexity in decision-making.
Incorrectly placed patients end up at the wrong level of care and/or being treated by clinical staff who do not specialize in the condition for which the patient was admitted. This can lead to slower recovery times and even clinical complications. Getting the right patient to the right bed at the right time can reduce LOS.
The inpatient census is notoriously volatile in most hospitals. Spikes in the census cause huge difficulties in capacity management, staffing and patient placement. Accurately predicting patient census can be vital for daily unit management. Detecting future spikes in the census allows hospitals to staff accordingly and balance elective admissions with spikes in ED volume.
The flow of patients from the OR is significant and can cause spikes in the inpatient census but is more controllable than the census contribution from the ED. Optimizing the elective surgery schedule with respect to recovery time yields a flatter inpatient census.
At the end of a patient's stay, there are many avoidable delays in discharge, such as issues with insurance documentation, transport delay and lack of space at a specialized nursing facility. These delays could be avoided if case managers were alerted to the problem earlier in the patient's stay.
The process of admitting patients from the ED is time-intensive, highly variable and frequently leads to delays. Difficulties in communication between ED providers and hospital physicians together with delays in having the right bed ready on time are the two major bottlenecks in the process. Visibility tools can allow physicians to identify delays in the system and react accordingly.
Most hospitals employ a general approach to physician rounding with the activity usually occurring in the late morning or early afternoon. This timing can lead to a missed opportunity to discharge patients early in the morning.
Hospitals typically prioritize clinically urgent cases in the lab queue; less urgent cases are usually first-come, first-served. Moving a patient close to discharge up in the queue can avoid delays.
In some cases, it is more cost-effective to schedule certain procedures as outpatient rather than inpatient, particularly if the patient is local.
Sanjeev Agrawal is president and chief marketing officer of LeanTaaS iQueue. Sanjeev was Google's first head of product marketing. Since then, he has had leadership roles at three successful startups: CEO of Aloqa, a mobile push platform (acquired by Motorola); VP Product and Marketing at Tellme Networks (acquired by Microsoft); and as the founding CEO of Collegefeed (acquired by AfterCollege).
Sanjeev graduated Phi Beta Kappa with an EECS degree from MIT and also spent time at McKinsey & Company and Cisco Systems. Sanjeev is a Forbes contributor and also writes on his personal blog at
http://medium.com/@saagrawa. He is an avid squash player and has been named by Becker's Hospital Review as one of the top entrepreneurs innovating in Healthcare.