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Downstate Times

The Newsletter for SUNY Downstate
University Hospital of Brooklyn

Length of Stay Rounds:
A Strategy for Success


(L to r): Rachael Saibu, case worker, Transplant; Diane Charet, director, Social Worker; Elizabeth Igboechi, Nursing; Carol Rowe-Johnson, supervisor, Case Management; Cheryl Rolston, Sr. TH. associate administrator, Nursing, Nelcia Trim, ADN NS82; and Joy Castro, interim director, Case Management, who leads the team. Not shown: Dr. Mafuzur Rahman, director, Hospitalists; Karen Lemer, Pitts Management.

One of the things that keeps hospital administrators up at night is the throughput issue.

"Throughput" refers to the cycling of patients through a hospital's physical resources -- beds, procedure rooms, imaging facilities, and so forth. Efficient management of throughput is an essential strategy for growth and for adding capacity to a hospital's ability to admit patients.

Inefficient throughput can negatively impact a hospital's bottom line. Most patient admissions have an estimated length of stay prescribed by third party payers for conditions or procedures. Additionally, if patients are not discharged on time, the emergency department gets backed up, with cascading results. Patients wait for too many hours in the ED, because ED beds are occupied by patients waiting for beds in the inpatient units.

On the inpatient units, length of stay rounds help to facilitate discharges. They also help to facilitate patient placement to rehab or nursing homes.

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At Downstate, we initiated length of stay rounds in April 2013. They are conducted every Wednesday at 9 am, and start from the 8th floor down to the 3rd floor, except for the psychiatric unit.

At these rounds, all patients who have been in the hospital for 7days and above are evaluated, with continuing stay justified by the nurse managers on the unit, social workers, case workers, and doctors/ providers caring for these patients.

This reflects the fact that optimizing throughput is a process that involves multiple connections and interdependencies. It requires communication between departments, and with support services, transport, timing of tests and physician discharge rounds -- all elements that play a role in efficiently moving patients through the system.

Early results are encouraging: between March and July, UHB's average length of stay dropped from 6.1 to 5.5 days.

It is evidence-based that discharges that occur on or before targeted length of stay help to decongest the ED. Improved hospital throughput also has another benefit: By helping to ensure that patients are seen timely in the ED and admitted onto the units, patient satisfaction improves.

By Elizabeth Igboechi, RNC-OB, MSN, FNP, NEA-BC
Director of Nursing, Women & Children / Transplant / Dialysis