1. Length of Stay Reduction Project – UMMCH Unit 6
MMRB presentation

2. Disclosure
Funding: internal only

3. Quality gaps we aimed to address
Reducing Length of stay (LOS) has impact on reducing healthcare costs, especially for those on Observational Status = ↓COST
Reducing LOS can significantly impact throughput and hence patient access to hospital resources = ↑ Quality & Safety
Often cited concern in reducing LOS is that it may result in increased readmissions.

4. Factors Impacting DC Timing
Attending/team rounding
Completion of DC orders
Pharmacy Rx dispensing and education
Interpreter services
Scheduling home health services, meds, equipment
Nursing education
Patient education – learning center
Flu shot
Family ride

5. Primary AIM: Decrease the average LOS (ALOS) of our Peds patients on Units 6 from baseline 5.8 days to 5.3 days within 2018.
Measures:
ALOS averaged over last 12 months (outcome)
Mean discharge time before 11 am (process)
Interval from DC order time stamp to actual patient departure (process)
No increase in readmissions (balance)

6. LOS Project Interventions: Phase 1 focused exclusively on Peds Hospitalist pts
“Discharge Care Coordination Huddle” Mon-Fri from 8:45-9am
Intervention 2:
“Discharge rounds” – purposefully round on planned/likely patient DCs from 9-10am
Round & sign orders to DC home
Avoid scheduling routine things (such as Interpreters) for non-DC patients during this time
Intervention 3:
“Tuck-in rounds” – Daily from 2-4pm, Team to run list or revisit patients with focus on:
Who is potential DC for next day?
Have DC meds been reconciled?
Is family aware of potential morning DC regarding ride planning?
If flu season, has flu shot been reconciled?
See next slide for more details
Intervention #1 implementation:
Jan 21, 2018
Interventions 2&3 simultaneous implementation: May 8, 2018
May 2018

7. LOS REDUCTION PROJECT
PHASE I was initiated with Gen Peds Hospitalist teams on 1/21/18

8. Outcomes:

9. Project Outcomes: Unit 6
LTM ALOS goal of 5.3 days was achieved for Unit 6!!!
Last 12-month (“LTM”) data

10. Project Outcomes: Unit 5
LTM ALOS on Unit 5 has increased over study period, but Peds Hospitalists manage a small # of Unit 5 patients, so future PDSA cycles with other specialty groups will have more impact there.
Last 12-month (“LTM”) data

11. Process Metric: Distribution of Discharges by Time of Day
All of 2017
1/21/18 – 9/4/18
The peak on the baseline at 2pm has shifted & leveled out, with more of the discharges happening earlier in the day

12. Process Metric: Discharge Order to Pt Discharge Time Lag, Unit 6
Goal: The time from Discharge order written to actual discharge is 60 minutes or less 80% of the time.
Intervention cycle began March 21, 2018 to current
N Mean StDev
Baseline Time From DC order
After Time From DC order
Estimate for difference: P-Value = (Last month 0.366) = no significant difference
Unit 6 Order to Discharge
Baseline
After
P Value
60 Minutes or Less
25%
27% same as last month
.289
120 Minutes or Less
54%
57% same as month
.211

13. Balance Metric: Unit 6 Readmissions (Jan 2016 - May 2018)
Intv’n #1
Intv’n #2
This represents random variation. From Jan-May 2018 (our study period) no significant changes were noted, compared to pre-intervention Jan 2016-Dec 2017.

14. Spread/sustain strategies
Project is ongoing
Working with nurses on a few interventions to impact DC order to actual DC time lag
Will be spreading these 3 interventions to other Pediatrics attending services shortly: Pulm/Cards (already started), GI & Nephrology
Dissemination plans via internal communications or publications are still under discussion