Background: Our Hospital (Two Campuses A and B) is a part of Yale New Haven Health System (YNHHS). YNHHS is a nonprofit healthcare system in New Haven, Connecticut. Average length of stay (ALOS) for inpatients at Bridgeport Hospital remains longer than the national average. With the recent acquisition of another campus, inpatient volume at our institution increased in 2022 as compared to 1-2 years. It has anticipated to increase further with a steep increase in surgical cases, cardiac catheterizations, and inpatient transfers from outside hospitals. The medical complexities of these patients are associated with longer inpatient lengths of stay, which decreases overall bed turnover. As there is no plan to increase the medical bed footprint, a 9 AM huddle is proposed to improve the workflow by aiming for an increase in 11 AM discharges and, thus decrease in ALOS
Purpose: Many institutions have utilized an interdisciplinary approach to discharge planning to streamline the discharge process and avoid variance. Like offering assistance to obtain medications, durable medical equipment, outpatient follow-up appointments, etc. Often, patients are discharged to a short-term rehabilitation center for physical therapy or skilled nursing needs. Team members follow a well-scripted format to discuss patients on a specific unit, paying attention to 11 AM discharges and potential barriers.
Description: Discharge planning requires adequate communication among the team members for timely discharge; a 9 AM huddle is a quick run-down of previously identified/ marked discharges from TCR (transitional care rounds). 9 AM huddle key participants include the Hospitalist, care coordinators, and unit clerk. For the study period October 2021 through September 2022, there was an improvement in ALOS, and a significant increase at 11 AM discharges on all participating medical-surgical units, compared to the same units a year prior. Overall, patient volume in these units is higher in 2022 than in 2021, corresponding to hospitals increase in inpatient volume. Our Hospital’s case mix index (CMI), in both surgical and medical populations, continues to increase, reflecting a higher overall acuity of our patient population. With consistent participation in these rounds, ALOS for all units participating improved steadily and decreased excess days per case and length of stay per case. Despite increasing patient volumes and higher patient acuity, our hospitalized patients’ overall length of stay improved, likely due to the 9 AM huddle. ALOS with outliers (inpatients with extended stay, over 20 days) continues to be higher than geometric LOS.
Conclusions: Hospital B was acquired by hospital A in June 2019. Hospital A and B’s growth in 4 years is 26% and 19%, respectively. CMI or acuity of the patient population and the corresponding LOS for FY2021 through FY2022. From April, FY2022 introduction of 9 AM huddle and increase in 11 AM discharges has significantly reduced the ALOS. CMI/ medical acuity of the patient population and the corresponding LOS for FY2021 through FY2022. From April, FY2022 introduction of 9 AM huddle and increase in 11 AM discharges has significantly reduced the ALOS. ALOS for patients discharged by 11 AM, which is almost ½ a day to 1 day less than those discharged after 11 AM. The shift in early discharges resulted in an overall improvement in average excess days per case on our intervention units. TCR and 9 AM huddle contributes to patient flow from admission to discharge.