How Innovation Is Changing Length of Stay
By Eric Wicklund
One of the key metrics in clinical care is patient length of stay (LOS), traditionally defined as the time between a patient’s admittance and discharge from a hospital. LOS is a critical factor in everything from reimbursement and accreditation to patient satisfaction and clinical outcomes.
New technologies like AI and concepts like remote patient monitoring (RPM) and Hospital at Home are helping healthcare executives gain a better understanding of LOS, and in turn they’re reducing costs and improving care management.
“We usually think about length of stay as an inpatient issue, but it really isn’t,” says Hsieng Su, SVP and Chief Medical Executive at Allina Health. The Minnesota-based health system has seen double-digit reductions in average LOS by improving care coordination between its 12 hospitals and various care sites, improving outcomes and opening up beds for new patients.
The key, Su says, is to understand the relationship between hospitals and other care sites, like skilled nursing facilities (SNFs), rehab centers and even the home, and developing a care management plan for the patient that makes the best use of those sites, rather than adhering to old protocols or patterns. That means collecting and analyzing data on the patient and various sites of care outside the hospital and finding the best care pathway.
While the LOS issue reached its peak with the pandemic, when hospitals were swamped with patients and struggling to find places to care for them, its roots go much farther back, to when healthcare organizations began setting expectations on how long a patient would have to be in a hospital to receive treatment for certain health concerns. Arrayed against those expectations were the costs of keeping a patient in the hospital and the amount that a health plan or payer would pay for that care.
Nowadays, those assumptions are being upended. Patients can be admitted to a hospital for surgery and discharged within a day to another care site. Healthcare organizations are using RPM and telehealth to monitor patients at home (or another facility) who might otherwise spend an extra day or two in the hospital.
That’s why it’s critical for healthcare executives to have a clear understanding of their options to the inpatient stay.
Su says the push to develop a better LOS strategy came out of the COVID-19 pandemic, when inpatient beds were at a premium and more than 100 patients each day were ready to be discharged, but hospital staff couldn’t find the right facility to take them.
Allina launched a partnership with Navvis to reduce those bottlenecks and backlogs through improvements in “patient throughput”. In the first 12 months of that partnership, the health system was able to reduce average LOS for discharge to an SNF by 1.61 days and by .89 days for discharge to a home health program. The health system also saw reductions in ALOS to hospice care and LTACH facilities.
This, in turn, enabled the health system to free up 25,000 days of capacity, or room for an additional 5,000 patients.
“Nobody really wants to be in a hospital unnecessarily,” Su points out. So it’s in the best interests of both the patient and the health system to find the right resources to reduce that LOS.
She says traditional care huddles have focused on clinical care, but now the conversations are more holistic, centered on what the patient wants as well as needs. Care managers and social workers are incorporated into the conversations, and plans are to add caregivers and even family members.
“This is a very clear conversation,” she says, about the patient’s care journey, with data to back up the various care pathways. For example, she says, a patient admitted with pneumonia should be hospitalized for three to five days depending on current protocols, but that LOS can change depending on factors like the patient’s response to treatment, availability of rehab beds or even the hospital’s ability to use RPM or telehealth to care for that patient at home.
“I’m seeing in so many programs now that in many cases, these clinical programs don’t really think about what happens in the home when these things move to the homes,” Su says. “They have to be thought out.”
“We want to make sure they don’t end up coming back to the hospital,” she adds.
At the end of the day, Su says, Allina is reducing the time that patients spend in a hospital by giving them better options, and the health system is using technology to make sure those options are safe and effective. This reduces the cost of care, improves the patient’s outcomes and outlook, and enables the hospital to care for more patients who need to occupy those inpatient beds.
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.