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March 3, 2020

The surprisingly simple way University Hospitals reduced length of stay

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    Doctors at University Hospitals Conneaut Medical Center were able to reduce the average length of stay for patients with chronic obstructive pulmonary disease (COPD) by more than two days by holding a daily, 11:00 a.m. meeting, according to a study published in the Journal of the American Osteopathic Association, Ginger Christ reports for the Cleveland Plain-Dealer.

    7 lessons to proactively manage patient flow

    Integrated care conferences

    Ryan Shilian, an osteopathic allergy and immunology fellow at UH Cleveland Medical Center and a co-author of the study, noticed during his time as a resident at UH Conneaut that staff would hold a daily, 11:00 a.m. integrated care conference (ICC) focused specifically on discharging patients. During the meetings, all staff involved in discharges would get together and determine what was needed to safely discharge a patient.

    That's different than what occurs in most hospitals, Christ reports. According to Christ, typically, hospitals' primary physicians coordinate with several departments before a patient is able to be discharged—and that often can result in delays.

    "You have patients sitting while the primary team was busy coordinating care," Shilian said. "In the meantime, the patient was ready for discharge."

    Shilian said he experienced such delays during his residency. Sometimes, Shilian would have as many as 10 patients who needed his attention, so he would prioritize the most serious cases. "Discharge takes a back seat," he said.

    How ICCs speed up patient discharges

    But Shilian and colleagues in their new study found that the ICCs at UH Conneaut sped up discharges for certain patients.

    For the study, Shilian and colleagues compared length of stay among COPD patients at UH Conneaut to those at UH Bedford, which has a similar patient population and capacity as UH Conneaut but did not conduct daily ICCs. They found that COPD patients at UH Conneaut had an average length of stay of 3.37 days, compared with an average of 5.55 days at UH Bedford. Further, the researchers found that length of stay at UH Conneaut was 67% lower for COPD patients ages 40 to 69 at UH Conneaut and 36% lower among COPD patients 70 and older when compared with UH Bedford.

    Shilian said the findings are important because patients are at a higher risk for falls and other conditions, such as delirium, the longer they stay in a hospital. He added that a shorter length of stay also means lower costs for both patients and hospitals, and it frees up space for hospitals to treat more patients.

    Shilian said that, based on the ICCs' success, University Hospitals is planning to expand the meetings to other hospitals in the region and eventually throughout the entire health system (Christ, Cleveland Plain-Dealer, 2/24; Shilian et al., Journal of the American Osteopathic Association, March 2020).

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