Reduced length of stay and 30-day readmission rate on an inpatient vascular surgery service

Abstract

Background: As the cost of care for patients with specific diagnoses becomes fixed, hospitals must develop systems to reduce length of stay and optimize the utilization of hospital resources while maintaining a high quality of care. The goal of this study is to evaluate the implementation and efficacy of a system designed to reduce average length of stay on a vascular surgery service. Study Design: To effectively reduce our average length of stay we restructured patient rounds, implemented multidisciplinary rounds, introduced clinical pathways to post-operative care, and expanded outpatient management of post-operative patients. 1697 adult vascular surgery patients discharged while under the medical direction of a vascular surgeon between 7/1/2013 and 6/30/2016 were included in the study. Results: Improving communication with critical staff and utilizing procedural space outside of the main operating rooms led to a 2.8-day reduction in length of stay (10.8 vs 8.0, P < 0.001). There was a trend toward a reduction in 30-day readmission rate (12% vs. 10%, respectively; P = 0.01) and no significant difference in case-mix index as a measure of illness severity (2.5 vs. 2.4, respectively; P = 0.15). Length of stay reductions were heterogeneous among the types of vascular disease studied, with greater improvements seen in patients undergoing lower extremity amputation, lower extremity angiogram, and endovascular aneurysm repair for non-ruptured abdominal aortic aneurysm. Less pronounced differences were observed in patients undergoing carotid artery endarterectomy/stenting and lower extremity bypasses. Conclusions: Restructuring team rounds and instituting a multidisciplinary approach to discharge planning produced significant reductions in length of stay without a deleterious effect on patient care that may impact hospital profitability.

Impact of Length of Stay on Readmission in Hospitalized Patients

“…Some authors have measured the impact of interventions on LOS and readmissions. Multidisciplinary rounds, e.g., on a vascular surgery service, were found to decrease LOS but not lead to any significant effect on readmissions [10]. We have previously shown that decreasing observation LOS in a hospitalist-run clinical decision unit is not associated with an increased rate of emergency department visits or readmissions [11].…”

Interventions to Prevent Readmissions in Hospitalized Peripheral Vascular Surgery Patients: A Systematic Review

“…Length of stay was a variable of interest for several studies. Decreases in average length of stay of 2.8 to 2.9 days was reported in two studies (Aicher et al, 2019;Reed et al, 2004). Interestingly in two studies the length of stay increased slightly post-intervention, but this increase did not reach statistical significance and tapered off over time (Rümenapf et al, 2013;Sharma et al, 2017).…”

“…One study decreased readmission rates from 16% to 8% in ischemic diabetic vascular surgery patients (p < .001) through the use of an integrated case model to improve individualized care planning, coordinated discharge need provision, and home follow up (Rümenapf et al, 2013). A second study used multidisciplinary team restructuring, combined with advanced practice provider leadership and telephone follow-up to decrease readmission rates from 12% to 10% (p = .010) (Aicher et al, 2019). Two studies noted significant decreases in some, but not all vascular surgery readmission rates.…”

The Importance of Improving the Quality of Care Among HIV/AIDS Hospitalizations in Portugal

“…Previous reviews supported the evidence that there is great potential for decreasing costs by targeting deficiencies in quality, and accordingly we can maximize the benefits given the available resources (19–24). Two important quality measures had obtained growing attention as a benchmark indicator for measuring hospital's performance, thirty-day readmission rate, and length of stay (LOS) (22, 25–28). However, despite being optimal methods for assessing hospital's performance, there remains a scarcity of research pertaining to the factors that can influence these quality indicators, especially when it comes to assessing hospitalizations among HIV/AIDS patients in Portugal.…”

“…Using length of stay as a hospital performance measure will allow us to impact cost and quality through payment incentives for hospitals or health care providers. For example, if a hospital reduces length of stay and accordingly the other associated resources and costs, the hospitals will be more efficient through maintaining a higher marginal return on each per admission payment (22).…”