Background:
Hospital throughput, which is defined as the volume of services provided in a unit time, may be targeted for quality improvement as a means of facilitating better utilization of existing inpatient bed capacity, expediting turnover, discharges, and reducing length of stay. We sought to identify factors associated with delays in hospital throughput at an 1100‐bed tertiary care center.
Method:
We developed and implemented a web based discharge delay tool (DCDT) to investigate operational inefficiencies in the delivery of care to acutely hospitalized patients. DCDT was an adaptation from Japanese automobile manufacturing industry where operator identified deficiencies in the production line, were used to trigger the termination of a faulty process, and allow for appropriate troubleshooting prior to continuation. DCDT is accessible from all hospital workstations and captured discrepancies between observed versus expected length of stay referred to as opportunity days. Outcome measures were opportunity days lost over a period of six months and their associated reasons.
Summary of Results:
A total of 679 opportunity days were lost over the 6 month observation period. Procedural delays (32.5% [95% confidence interval 29.1% ‐ 36.2%], sub‐specialty consults 30.6% [27.6% ‐ 34.6%], and post acute placement such as sub‐acute rehabilitation 23.5% [20.9% ‐ 27.4%] and skilled nursing placement 13.3% [10.6% −15.8%] accounted for majority of opportunity days lost. Of the procedural delays (21%), non‐invasive testing which included echocardiograms and radiological imaging were more common than invasive procedures (11.4%) as cause of delays (p < .001).
Statement of Conclusions:
Inefficiencies in common processes of acute hospital care contribute to opportunity days lost and may be important targets for prospective quality and operational improvement initiative utilizing health information technology and clinical decision support systems.
Author Disclosure Block:
A. Usmani, None; C. Phillips, None; S. Suri, None.