Reducing Hospital Length of Stay: A Multimodal Prospective Quality Improvement Intervention

Area of Science:

• Healthcare Management
• Quality Improvement
• Hospital Operations

Background:

• Prolonged hospital stays increase risks and costs.
• Reducing length of stay (LOS) without compromising patient outcomes is a national priority.
• The study focuses on improving LOS and LOS index (LOSI) at an urban academic safety-net hospital.

Purpose of the Study:

• To systematically and safely improve hospital length of stay (LOS) and LOS index (LOSI).
• To evaluate the impact of a quality improvement initiative on LOS metrics.
• To assess the sustainability of LOS improvements in a safety-net hospital setting.

Main Methods:

• A multifaceted quality improvement initiative was implemented in a 550-bed hospital.
• Interventions included institutional investment, data analytics, and DRG-focused LOS reduction strategies (sepsis, obstetrics, psychiatry).
• Statistical analyses compared pre- and postintervention outcomes from mid-2019 to 2023.

Main Results:

• Mean LOSI significantly improved postintervention (1.15 to 1.02, p < 0.0001) and was sustained for over three years.
• Average LOS showed a clinically relevant, though not statistically significant, improvement (6.24 to 5.91 days).
• Excluding outliers, LOS showed a statistically significant improvement in postintervention slope change (-0.02 per month, p = 0.04), with no adverse effects on readmissions or mortality.

Conclusions:

• A multifaceted quality improvement approach effectively reduced LOS and LOSI in a safety-net hospital.
• The initiative demonstrated clinically significant and sustained improvements.
• Integrated strategies and organizational commitment are key to successful LOS reduction.