Thursday, November 29, 2012

Dramatic decreases in hospital lengths of stay can occur. Here's how

I recently wrote about my plan to reduce hospital readmissions. Now I will discuss the problem of reducing length of stay.

The recent hurricane in New York City and the closures of some hospitals requiring the transfer of a large number of patients reminded me of something that happened on 9/11/2001.

I was working at a hospital near New York. You may recall that among the many problems that day was a breakdown in communications. Reliable information on the number of casualties and extent of injuries was hard to determine.

Late on the morning of 9/11, a meeting was held at my hospital. We canceled all elective surgery and decided to discharge as many patients as possible in preparation for the injured who, sadly, never arrived. Victims either got out of the World Trade Center and walked away or perished. Injured patients were few and were cared for by hospitals in New York.

Unaware of what was really happening in the city, we made rounds on every patient and discharged nearly 50 who otherwise would have stayed a day or two longer. As far as I know, there were no complications related to what seemed to be a premature departure from the hospital for many.

The next day someone wondered why, if we were able to discharge so many patients on the day of a disaster, could we not do so more often?

Granted, once a wholesale cleanout took place, there would probably not be 50 patients eligible for discharge every day. But it might be 10 or 15. Multiply that by a few thousand hospitals and you might see quite a savings in the cost of medical care.

Will it happen? I doubt it. For one thing, ours was not the only hospital to have that experience. If it was going to happen, it would have caught on by now.

Why not? On 9/11, the inpatients were motivated to leave. They were scared. They wanted to be with their families. They felt like they were helping others—the potential victims who never materialized. It would be hard to muster those feelings every day.

I have written before that hospital length of stay is not simply a matter of the physician deciding that a patient can go home. The patient may not want to leave. There may be no support at home. There may be no one to drive the patient home. The nursing home or rehab center may not have an available bed.

Still, it is interesting to contemplate what occurred on 9/11/2001 and why we can’t be more proactive in discharging patients.


M. Rahman said...

I wonder if a drive to reduce the length of stay will lead to an increase in readmission rates.

Alyssa said...

Physicians & patients also become much more motivated dischargers around the holidays...

Skeptical Scalpel said...

M-I think it's inevitable that reducing lengths of stay will lead to more readmissions.

Alyssa-That's a good point. It's similar to the phenomenon that occurs on Friday afternoons. General surgeons always get more consults as primary care seeks to decrease their patient load for the weekend.

Laurie Mann said...

I really hate being in the hospital. When I had a hysterectomy over the summer, my doctor said I'd be in for 3 nights. I felt OK after 2, was up and around and my vitals were fine. I wanted to go home and I did.

Skeptical Scalpel said...

Laurie, I would say that you represent a minority of postoperative patients in my experience.

Don said...

Hospital food is another discharge motivator.

Skeptical Scalpel said...

Don, you are so right. I have always said that if you are bitching about the food, you are well enough to go home.

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