As advocates of reducing length of stay by centralizing patient transition data and operation within the Access Center, we’ve zeroed in on length of stay as one of the most important yet overlooked aspects of the acute experience. And that’s because this seemingly straightforward part of the patient experience can have significant impacts across so many hospital processes.
We’ve identified five key areas where avoidable days, i.e. unnecessary additions to length of stay, can make a negative impact.
Conversely, trimming length of stay, even by a matter of hours, can open up significant opportunities for positive growth in these same areas.
Let’s look at each of these in turn and explore how length of stay could be affecting your facility in ways both expected and unexpected.
Perhaps the most obvious impact of an extended length of stay is on clinical capabilities and outcomes.
From a sheer numbers standpoint, the longer an individual occupies a bed in your acute facility, the longer that person will require clinical attention from staff whose time could be better spent elsewhere. Now, if the individual is in question truly needs the level of acuity provided by the bed they’re in, that’s certainly appropriate. You don’t want to discharge that individual before they’re clinically ready for discharge.
But when the person remains in the bed following completion of their care episode, that’s when problems escalate. Imagine a patient has stabilized and is awaiting discharge and transportation to a rehabilitative care center or a skilled nursing facility. While they wait, they’re still being examined by nurses whose schedules might be best spent on patients requiring more intensive help. And their chart remains within the purview of a physician whose attention can and should be spent on more at-risk individuals.
So while the patient languishes in the bed, your labor hours aren’t being maximized to their fullest extent. Complaints during this transition period edge up. In addition, the risks of hospital-acquired infections, falls and other adverse reactions also increase during this period.
There’s also financial incentive for moving patients to a more appropriate bed (and its attendant level of acuity).
The most pressing financial issue is patient throughput. The faster you can get a patient out of their high-acuity bed and onto the next level of care, the better, as that means the next patient can take their place more quickly.
Getting patients in and out of the hospital efficiently is a way to keep your revenue model churning. Stagnancy brings standard forecasting models to a halt, because the revenue from an incoming patient may not materialize, or at the very least it will be delayed or reduced. From a financial standpoint, you want to be able to accept each new patient, and if that’s not possible because your staff are occupied with a patient who doesn’t need the bed or the bed itself isn’t available, you’re missing a readily-available incremental revenue opportunity.
If you’re ever in a position where you’re turning away patients because length of stay is keeping patients in beds longer than necessary, let’s talk. That’s a chance at revenue – and a chance to deliver more widely on your mission – that simply shouldn’t be missed, and we’ve seen the difference a full-fledged patient access center can make.
Let’s look at the view from 30,000 feet, analyzing your health system strategy at the macro level.
You have a maximum number of beds, a maximum number of staff, of operating theatres, of X-ray systems, etc. You want to provide exactly the care needed by an individual the moment they need it. But the moment they don’t need it, resource utilization plummets. It’s in this grey zone where you need to get patients to a more appropriate acuity level quickly.
We worked with one health system that routed every patient referral to their main campus, regardless of their needs. The reason was simple: they’d always done things that way. Their health system had evolved from having its original hospital as its anchor, and that idea remained ingrained in the culture.
They were failing from a strategic standpoint, because that main hospital campus had beds occupied for too long, and new patients couldn’t get in the door. Meanwhile, the secondary hospitals and satellite facilities that would have been able to care for and discharge patients more quickly were being under-utilized.
Upon establishment of a patient access center, this health system was able to reroute patients appropriately. Not only did length of stay improve, but they were able to see more patients and standardize care expectations across the entire organization.
Looked at in this light, mishandled length of stay is a strategic problem. And it’s when you start approaching it with the same vigor that you would any other problem at your hospital that you can realize extensive cost savings, revenue growth, and improved outcomes.
Length of stay affects a wide variety of health systems operations. The following is a list of the big ones, but rest assured there are even more than this:
This is a nightmare from an operational standpoint. In order to run efficiently, each of these areas and so many others need to be predictable so that you can schedule staff, order supplies and equipment, estimate revenue and more. When there’s a snag in any one area, the forecast you ran to determine your budget and revenue is compromised. This puts more work on hospital accounting and finance teams, who have to adjust their calculations accordingly. Revenue cycle management is all but impossible when this becomes a regular occurrence.
If you can get length of stay to a predictable place, where patients are discharged precisely when they need to be and not a moment sooner or later, you can streamline your operations accordingly.
Finally, the patient experience can be severely compromised if the individual must wait in a bed for longer than is clinically necessary.
The risk of infections, falls and other adversity increases. But even if an adverse event doesn’t happen, how the patient feels about their overall experience will be negative. Individuals want to get home or to their next healthcare stop as quickly as possible. They want to be on the road to recovery and surrounded by family and friends. They want to put their acute care stay in the rearview mirror.
Avoidable days prevent the patient from reaching that milestone, and they will also temper the patient’s attitude toward your organization. For all the talk of consumerism in the modern healthcare marketplace, patients are by and large a very loyal bunch. When you provide an extraordinary level of care and are able to discharge the patient quickly, improving their experience, they’re far more likely to come back, when, for instance, they need non-emergent, preplanned care. This statistic is certainly hard to gauge, as the payoff could take years and carry across numerous care episodes, but it’s no less important to your bottom line.
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores can, and will, suffer if patients must stay in one spot for longer than they need to, especially if something negative happens during that time. Alternately, if you can pleasantly surprise the patient by discharging them sooner than expected, your scores will improve.
Length of stay is a crucial piece of the patient experience, yet not one that always gets the attention it deserves. It’s time to start thinking hard about this critical aspect of your clinical capabilities.
Interested in learning how to eliminate avoidable delays? Contact us.