A 30-Year Retrospective: Degrees of Difficulty in Decreasing LOS

Area of Science:

• Healthcare Management
• Hospital Operations
• Quality Improvement

Background:

• The evolution of healthcare strategies has significantly impacted hospital operations over the past three decades.
• Reducing length of stay (LOS) has been a primary focus for acute care hospitals aiming for efficiency and cost-effectiveness.

Purpose of the Study:

• To provide a 30-year retrospective (1986-2016) on the development and implementation of strategies to reduce hospital length of stay (LOS).
• To highlight the author's involvement in creating tools and roles that facilitated measurable outcome-driven care.

Main Methods:

• Retrospective analysis of strategies implemented between 1986 and 2016.
• Review of tools such as critical paths and roles like clinical case management.
• Examination of operational systems for managing outcome-driven care.

Main Results:

• Average inpatient LOS decreased from 7.8 days in 1970 to 4.5 days in 2012.
• For patients aged 65 and older, LOS decreased from 12.6 days in 1970 to 5.5 days (2005-2010).
• Acute care hospitals doubled productivity without increasing direct care staff, with significant contributions from case managers and social workers.

Conclusions:

• Acute care services have achieved substantial reductions in LOS, demonstrating significant productivity gains.
• Case managers and social workers played an indispensable role in achieving these efficiency improvements.
• Future efforts should focus on reducing cost per case, particularly within risk contracts, building on past successes.