Background: Length of stay is an important marker for quality of care in the hospital. Increased length of stay can affect patient flow through the hospital and can lead to overcrowding, increased boarding in the emergency department, delays in inter-hospital transfer, and cancellation of elective procedures due to bed availability (1). In addition, longer hospitalizations for patients can also result in poorer health outcomes such as an increased incidence of nosocomial infections, pressure ulcers, and hospital associated deconditioning (2). Research has shown that multi-disciplinary approaches to discharge coordination can reduce hospital length of stay without increasing readmission rates (3). The purpose of our study is to describe the implementation of a discharge barrier escalation pathway at our hospital and evaluate the impact of the escalation pathway on reducing avoidable hospital days.
Methods: An escalation pathway was created at our academic- affiliated community hospital. The goal of the escalation pathway was to establish a more structured workflow and communication channel for which members of a care team can directly escalate discharge barriers to contact leaders. Escalations through the pathway were recorded and the total number of avoidable days in the hospital were tracked before and after the implementation of the escalation pathway.
Results: The escalation pathway went live at our hospital on July 1st, 2024. Common discharge barriers that were resolved using the escalation pathway included: discharge site coordination, outpatient care coordination, procedural delays, and imaging delays. In the four months leading up to the implementation of the escalation pathway (March 1, 2024- June 30, 2024), there were a total of 1042 avoidable days in the hospital, averaging to 260 avoidable days per month. In the four months following the implementation of the pathway (July 1, 2024- October 31, 2024), there were a total of 446 avoidable days in the hospital, or on average 111.5 avoidable days per month. This represents a 42.8% decline in avoidable hospital days following the implementation of the escalation pathway.
Conclusions: Our intervention demonstrated that having a streamlined communication channel for escalation of discharge barriers is effective in overcoming discharge barriers and reducing avoidable hospital days. We believe that a similar escalation pathway can be implemented at other hospitals to reduce avoidable hospital days. Future studies will be directed at the impact of the escalation pathway on other hospital quality of care metrics.
