Nursefriendly.com: Length of Hospital Stay

Friday, February 18, 2011

Released hospital patients' many unhappy returns

Patients who are released from the hospital too early or without proper planning and instructions often wind up back in the hospital after a few days, a problem that's costly to taxpayers and distressing to patients.

A study released today calculated that reducing hospital stays by a single day for Medicare and Medi-Cal patients in California adds up to $227 million a year.

An estimated 81,000 Medicare patients in California - or 20 percent - end up back in the hospital within 30 days of being discharged for some reason related to the same condition, the study found.

"Right now, when you go to the hospital, it's the do-it-yourself model. It's up to you to figure out what to do," said David Grant, author of the study for the California Discharge Planning Collaborative, a group of labor, senior and other advocacy organizations.

Patients, especially those who are elderly and lack social support, are often readmitted because they don't understand their discharge instructions, fail to take their medications or have complications that they can't handle.

via sfgate.com

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Wednesday, February 2, 2011

Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis -- Lipitz-Snyderman et al. 342 -- bmj.com

The US Institute of Medicine highlighted the serious problem of patient safety and importance of evidence based quality improvement initiatives to reduce adverse events.1 Evidence that quality improvement initiatives intended to reduce adverse events result in a measurable impact on other important outcomes, such as mortality and length of hospital stay, is limited. Without this evidence, hospitals and healthcare payers face uncertainty about whether investment in any specific quality improvement intervention will significantly benefit patients and represent a good use of limited financial resources.

The Michigan Health and Hospital Association Keystone ICU (intensive care unit) project, developed by researchers at Johns Hopkins and undertaken by the Michigan Health and Hospital Association, about 80 of its member hospitals, and researchers at Johns Hopkins Medical Institutions, is a recent example of a successful, large scale quality improvement initiative.2 3 4 The project adopted a comprehensive approach to improving patient safety that included promoting a culture of safety, improving communication between providers, and implementing evidence based practices to reduce rates of catheter related bloodstream infections and ventilator associated pneumonia. Evidence based interventions for preventing catheter related bloodstream infections were promoting handwashing, full barrier precautions, skin antisepsis with chlorhexidine, avoiding the femoral site during catheter insertion, and removing unnecessary catheters. Interventions to prevent ventilator associated pneumonia included a mechanical ventilator “bundle” consisting of use of semirecumbent positioning, daily interruption of sedation infusions, and prophylaxis for peptic ulcer disease and deep venous thrombosis.5 The project showed that measures of culture and infection rates in the intensive care unit were substantially improved for up to 36 months after implementing the quality improvement measures.2 4 5 6

via bmj.com