Background: Hospital length of stay has been an important measure of hospital efficiency and resource utilization. Increase length of stay results in higher cost and increased morbidity to patients. Length of stay outliers or “long stay patients” with complex discharges continue to remain a barrier to length of stay reduction.

Purpose: Our institution instituted a multidisciplinary Long Stay Committee to help facilitate the most complex discharges throughout the enterprise.

Description: The Long Stay committee is comprised of Medical Directors, the Chief Quality Officer, Directors in Nursing, Directors of Case management/Social work, Hospitalists, Risk management, Finance, Ethics, Psychiatry and Directors of Rehabilitation. The committee meets once a week to discuss cases. Case Management and Social work from each hospital fill out a tactical focus study on complex discharges and meet biweekly to discuss these patients. Following these discussions, the most complex patient discharges are brought to the Long Stay Committee. The committee has discussed over 163 cases. The barriers to discharge identified are listed in Table 1 with some patients having more than one barrier listed. 51% (83/163) of the cases are services attended by hospital medicine physicians. 82% (68/163) of those cases were from hospitalist attending only services while the remainder 18% (15/163) cases were from the hospitalist attended teaching services. From January through November of 2017 the committee added 113 new cases and has had 107 discharged cases.

Conclusions: Our institution’s Long Stay committee’s purpose is to use all available resources to find innovative discharge plans for our long stay and complex discharge patients. The committee has been successful in doing this. Lack of guardianship is one of the most encountered barriers (table 1). The long stay committee played an integral part in our institution partnering with the local county to form a guardian service board which facilitates guardianship appointments. Other solutions have included working with the patient and support persons to find appropriate discharge levels of care throughout the United States and other countries as well guiding them through the process to gain the necessary financial resources. The foundation of the committee’s success in coming up with innovative discharge solutions is the broad range of disciplines that attend this committee and the atmosphere of teamwork this provides. We look forward to collection of additional data on outcomes to further analyze this committee’s benefit to length of stay reduction.

IMAGE 1: Table 1