Background: Length of Stay (LOS) can provide important information regarding the efficiency and quality of patient care. Often, LOS is used as a proxy of efficient hospital management because reducing LOS can allow capacity for emergent admissions and interhospital transfers.2 Increased LOS is associated with negative patient outcomes including increased risk for mortality, hospital acquired infections, mental health illnesses, and reductions in patient mobility.3 Multidisciplinary rounds (MDR) can improve patient care by encouraging interdisciplinary communication. MDRs are vital in gaining shared knowledge of the patient’s status and are associated with smoother patient care flow, decreased LOS, and improved patient and staff satisfaction.1 MDRs consist of healthcare providers from two or more disciplines who meet to make joint decisions regarding the patient’s care progression. 4,1Before August 2023, the healthcare team at a 386 bed suburban hospital in Florida was not achieving their LOS goal. To address this issue, the hospitalist team implemented multiple tools to help improve their LOS.
Methods: In this study, a hospitalist group at a 386 bed suburban hospital developed a multifaceted approach to improving LOS by implementing MDRs, utilizing the ADOT tool in Epic, and implementing the LOS Toolkit in Zenith.The format of centralized MDRs was discussed with representatives from C-Suite, care management, nursing, and physicians from each hospitalist group in Spring 2023 and went live in August 2023. Centralized MDRs were held daily, in the morning after rounds. Each inpatient unit was represented by a table staffed by one representative from nursing, care management, social work, and pharmacy. Each physician walked to tables where they had patients and discussed each patient for about 60 seconds with the team. Physicians could escalate problems involving imaging, infection prevention, or therapy to the resource island. Typically, there were 5 physicians simultaneously participating in MDRs with each discussing a maximum of 18 patients per day. In addition to MDRs, an ADOT-LOS column was added to both group and individual patient lists in May 2023. This feature helped physicians easily identify patients who are ready for discharge by estimating the date of discharge with a clock symbol. Clicking on the clock symbol prompted a list of barriers to discharge, as entered by the physician. The list was also visible to case management and nursing. The team also incorporated the LOS Toolkit in Zenith which has various tactics to reduce LOS. Areas of improvement were selected pertinent to the hospital and action items were developed which included capturing the severity of illness accurately with the case mix index (CMI).
Results: Since implementing MDRs in August 2023, LOS significantly improved, and there has been a perceived reduction in the number of calls to providers in this hospital system. Additionally, using the ADOT tool in Epic correlated with decreased LOS. Through this tool, patient care was coordinated among providers more efficiently. The utilization of the LOS Toolkit in Zenith enhanced the accuracy of the expected length of stay, leading to sustainable improvements in patient care.
Conclusions: The implementation of MDRs, the ADOT tool, and the LOS Toolkit have all contributed to a significant improvement in the LOS metric, increased provider coordination and communication, and streamlined discharge planning.