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A multidisciplinary approach to decreasing length of stay in acute care surgery patients
Christopher D DePesa1, Majed W El Hechi1, Rachael McKenzie2
1Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
Aim:
To decrease hospital length of stay in acute care surgery patients.
Design:
An observational cohort quality improvement project at a single tertiary referral centre.
Methods:
A multidisciplinary team of physicians, nurses, case managers, and physical and occupational therapists was created to identify patients at risk for prolonged length of stay and implement weekly multidisciplinary rounding, with a systematic method of tracking progress in real time. The main outcome measure was hospital length of stay. The observed/expected ratios for length of stay 2 years before (2012-2014) and after (2014-2016) the intervention were compared.
Results:
A total of 6,120 patients was analysed. Early identification and action on barriers to discharge created a significant decrease in risk-adjusted acute care surgery patient days per year (96 days) with limited added cost (1-2 hr per week). Patients discharged to home with or without services benefited most.
Conclusion:
Decreasing length of stay in acute care surgery patients is possible without adding a significant burden to healthcare providers.
Impact:
We describe a comprehensive, multidisciplinary initiative to decrease the length of stay of acute care surgery patients. Institutions can use existing resources in a sustainable manner to create a significant decrease in patient days per year with limited added cost. REGISTRATION: https://osf.io/zfc3t.
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