Integrating Services Helps Lower Length of Hospital Stay
Regional health system integrates services to reduce length of stay and improve care
A regional health system in Europe was having difficulty discharging elderly hospital patients in a timely fashion. The system knew that these patients were especially likely to need follow-up services from community health and social care providers—services that could be difficult to arrange. However, it also knew that delayed discharges jeopardized patients’ health and increased costs unnecessarily. The system therefore thought that closer integration of acute care, community health, and social care services could accelerate the discharge process. However, it was uncertain about how big a problem it actually had, whether integrated care was the right solution, and whether there were other steps needed to make the discharge process more efficient.
Over three months, Burk worked with the system to quantify its problem, identify the root causes of delayed discharges, and develop tailored solutions.
The team began with a detailed diagnostic to determine:
- How many elderly patients were being kept in the hospital once it was no longer medically necessary
- What procedures were being used to discharge those patients and transfer responsibility for their care to community providers
- Where bottlenecks were arising
As part of this process, the team combed the clinical literature and interviewed outside experts to identify international best practices for hospital discharge. In addition, it analyzed local hospital records and conducted interviews with a wide range of local stakeholders, including doctors, hospital and community health nurses, and social workers. It also worked with these stakeholders to develop ideas for how bottlenecks could be eliminated.
Several insights emerged:
- It became clear that poor communication among the various providers (e.g., between hospital nurses and community social workers) made many discharge procedures unnecessarily time-consuming and hindered the effective transfer of care from inpatient to the outpatient providers
- There was significant duplication of effort
- Considerable nursing time was being wasted on administrative tasks
The team then worked with the providers to design and test new discharge procedures. One of the key changes was the creation of a new position—the discharge coordinator—who would be responsible for communicating with all providers and alleviating the administrative burden on nurses. In addition, the paperwork required for discharges was streamlined to minimize duplication and smooth the transfer of care. The team also developed a solid business case to prove that the cost of hiring the discharge coordinators would be more than offset by the savings the health system would accrue once the patients’ length of stay was shortened.
The providers then tested the new discharge process in one hospital ward for several weeks, with support from the Burk team. The process was then piloted in two wards for a full year. The results were so positive that the new process was rolled out across the region and has been used now for almost four years.
As a result of the new discharge process:
- Elderly inpatients are now discharged as soon as is medically appropriate, and their average length of stay is 30% below the benchmark average for the country. The client has been able to maintain this low length of stay for several years.
- As the business case had predicted, the changes enabled the client to achieve more than €1 million in cost savings in the first year—savings that accrued to both the hospital and the payor.
- Improvements in the discharge procedures have helped ensure that elderly patients as possible can return to their own homes.
In addition, closer integration of acute care, community health, and social care services has reduced the rate of hospital readmissions among elderly patients.