An application of continuing medical education to decrease excessive lengths of stay

The focus of political and public attention on health care costs has created pressures on hospitals to devise effective methods to decrease costs and still maintain excellent medical care. After identifying four medical specialty services in a unit of a tertiary-care hospital where lengths of stay were excessive, even when the average severity of the discharged patients' illnesses in these services was considered, the authors developed two educational interventions to decrease lengths of stay. First, individual meetings were held with each of the attending physicians from three of the four specialty services, and the data on lengths of stay on that particular service were discussed. The fourth service was used as a control. Second, a continuing education meeting was held with attending physicians on all of the specialty services admitting patients to the unit. The data on lengths of stay for all services were discussed. The lengths of stay subsequently decreased significantly in the three targeted specialty services without any measurable change in the quality of care. This improved efficiency persisted for the 16 months after the intervention. Significant changes in length of stay were not observed in the control service or in any of the other specialty services in which the attending physicians experienced only the continuing education meeting.