Hospital length of stay reduction is an important mechanism for improving the outcomes and efficiency of care. This study evaluated the impact of length of stay reduction in the hospitals of Syracuse, New York. Between 2015 and 2020, length of stay reduction saved 7106 inpatient days for adult medicine, and 10,605 patient days for adult surgery in the hospitals.
Length of stay outlier patients, who remain in hospitals for extended periods of time, is an important challenge to the improvement of health care efficiency. This study identified outlier patients and programs to address them in the metropolitan area of Syracuse, New York. It demonstrated that, during 2013, outlier patients accounted for 2.4 percent of adult medicine discharges and an excess average daily census of 53.3 patients in the Syracuse hospitals. During 2013, outlier patients accounted for 4.3 percent of adult surgery discharges and an excess average daily census of 44.1 patients. In two studies, the Syracuse hospitals identified the need for multiple intravenous therapy, extensive wound care, and total parenteral nutrition in the community, as major causes of outlier stays in hospitals. Each of the hospitals has developed a program with a long term care facility to address these needs. Efforts to address outlier lengths of stay are also focusing on Potentially Preventable Complications in Syracuse. The mean length of stay for inpatients with post admissions complications was almost three times the stay for the medical/surgical population during 2013.
This case study described the structure and preliminary impact of a hospital program to improve efficiency by reducing long stays for adult medicine inpatients. The program focused resources on these patients, including an experienced case management staff, effective relationships with long term care providers, and Subacute and Complex Care services. The program caused the total number of adult medicine patient days associated with these patients to decline by 1593, or 4780 on an annual basis.
The needs of patients who can stay for extended periods in hospitals generate large amounts of health care expenses. They usually experience multiple diagnoses and their needs are not easily understood or served. This study described the efforts of the acute hospitals in Syracuse, New York to address the needs of these Complex Care patients. The hospitals developed a series of Subacute Programs, each of which addressed a single care need, which might have helped restrain the growth of adult medicine stays during a five-month period. The study demonstrated that reductions in adult medicine stays were associated with the introduction of Complex Care Programs that addressed multiple care needs, in 2015. The association between the implementation of the Complex Care Programs and length of stay reduction for adult medicine was present at the combined and individual hospital levels. The study suggested that the amount of Program Development Funds invested in these programs saved 2000 adult medicine days or $1,600,000 compared with total expenses of $292,000 during a five-month period. The experiences of the Syracuse hospitals suggested that small programs with simple structures could have a positive impact on health care efficiency at the community level.
This study evaluated the impact of severity of illness on hospital inpatients within the metropolitan area of Syracuse, New York, during January-December 2014. It demonstrated that patients with Major and Extreme severity of illness generated a substantial majority of the excess lengths of stay and adverse outcomes during this period. These patients were associated with 77 percent of the excess days for adult medicine and 100 percent of the excess days for adult surgery. They also generated hospital readmission rates that were at least 50 percent higher than those of patients with Minor and Moderate severity of illness. They were also associated with more than 75 percent of inpatients with the most frequent post admission complications. The data suggested that these populations need to be a focus of efforts to improve hospital efficiency and outcomes.
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