Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit

Abstract

BACKGROUND: Optimizing hospital operations is a critical issue facing healthcare systems. Reducing unnecessary variation in patient flow is likely to improve efficiency and optimize capacity for hospital inpatients. The objective of this study was to determine whether changing admissions, from a “bolus” system to a “drip” system, would result in a smoothed daily discharge rate, and reduce the length of stay of patients on a General Internal Medicine clinical teaching unit over a period of 1 year. METHODS: We conducted a retrospective analysis of the General Internal Medicine inpatient service at Toronto General Hospital for the 6‐month periods from March to August during 2 consecutive years. Length of stay distributions and daily discharge rate variations were compared between the 2 study periods. RESULTS: There were a total of 2734 discharges, 1446 occurring in the pre‐change period, and 1288 in the post‐change period. There was overall smoothing of the daily discharge rates, and a reduction of 0.3 days in median length of stay in the post‐change period (P = 0.0065). CONCLUSIONS: Restructuring the admission system to achieve constant daily admissions to each care team resulted in a smoothing of daily discharge rates and improved operational efficiency with shorter lengths of stay. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis

“…We found that racial/ethnic and SES differences in aALOS range from 0.15 to 0.25 days for those discharged home, and from 0.10 to 0.35 days for those discharged elsewhere. Given that previously studied strategies to lower average adjusted LOS across wards and healthcare systems led to reductions in average LOS by 0.3 to 0.7 days, 21,22,24 these persistent differences in aALOS along racial/ethnic socioeconomic lines may be both clinically consequential to patients and financially important for hospitals.…”

Use of a 90-Minute Admission Window and Front-Fill System to Reduce Work Compression on a General Medicine Inpatient Teaching Service

“…[4][5][6] Some programs have moved from a traditional bolus call system like ours (with teams taking new admissions on 1 day of the call cycle) to a drip system (with multiple teams taking fewer admissions daily), which has been shown to smooth daily discharge rates and statistically decrease length of stay. 7 However, the impact of a drip system on resident hours, workload, and education is unknown, and our approach may be a less dramatic and feasible way of smoothing call-related workflow. Trials of duty hour flexibility may move us toward fewer duty hour restrictions 8,9 ; yet even with duty hour flexibility, clustering of admissions would continue, keeping the findings from our intervention relevant.…”

Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

“…As hospital systems seek greater market share, higher bed occupancy rates, and increased net revenue, 12 they may seek efficiencies in LOS to lower costs. 13,14 Strategies to reduce LOS, including use of multi-disciplinary ward-based activities, 15,16 changes to work flow management, 17,18 and designing team structure, 19 have lowered average LOS from 0.3 to 0.7 days. 16,17,20 Although the mechanisms driving racial/ethnic and socioeconomic LOS differences remain unclear, it is possible that the strategies implemented may have greater impact on racial and ethnic minorities and patients with low socioeconomic status (SES).…”