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IMCU tests plan to reduce length of stay

17 Jul 2022

Daily ‘milestones’ may help patients heal and discharge faster

By: James Parr, executive vice president of operations and chief financial officer; Zennia Ceniza, vice president of clinical operations; and Christine Clarke, MD, chief medical officer, Salem Health Medical Group

Our hospital census has been consistently high for more than a year, often exceeding 100% capacity for our adult health and critical care beds. Patients are staying about a day and a half longer than in 2019. 

While that might not sound like much, it translates to 53,000 more days over the year, at an added cost of $75 million. If length of stay today was the same as in 2019, we’d have 80 fewer patients in the hospital each day.

Patients often heal faster at home while avoiding exposure to infection. A lower census would significantly decrease the burden on the system (overtime, supplies, facilities, etc.), while improving patient safety, staff resiliency, and throughput in the ED because hospital beds open faster.

Health systems around the country are struggling with this challenge. Because so many factors affect length of stay, no one has been able to identify a root cause — or even attempt this work. But Salem Health has stepped up!

Our Test of Change: Creating milestones

A collaborative Test of Change (TOC) began June 27 in the IMCU: A throughput team including a provider and nurse help staff identify clinical milestones that create an expected discharge date. Their hypothesis? If we create a visible discharge time with daily milestones, the care team can help patients meet the discharge date 95% of the time.

The TOC continues in IMCU with a plan to include another unit. We’ll share progress as the team gathers data. Thanks to our Lean management systems, this work uses data to drive decisions based on high quality care and excellent patient experience.

For a deeper dive into our situation, here's what we've learned.