This project concentrated on the collection, analysis, and review of data based on the needs assessment that explored the benefits of reducing LOS/excess days. The information under analysis emphasized on finding the issues affecting this problem. The target population included all the major stakeholders at the facility, such as the hospital administrator, patients, physicians, and nursing staff.
The data collected focused on the needs assessment of LOS as a healthcare issue and all associated factors. Some of the healthcare needs earmarked for further interpretation included the social-economic impact of LOS/excess days on patients, the hospital’s take on the issue, the intensity the issue, and the role of nurses in addressing LOS among others. The researcher figured that the solution to this problem would concentrate on the support of related interventions that reduce LOS.
For instance, Agboado, Peters, and Donkin (2012) look into identifying the differential impacts of health service, patient, geographic and temporal factors on LOS for chronic obstructive PD readmissions. The authors conducted a cross-sectional study to evaluate the relationship between LOS and these factors. They used resident COPD patients at a Blackpool hospital given data from April 2005 to March 2010.
Agboado et al. (2012) found that 2410 admissions met the inclusion criteria. Further, the median LOS was six days while the average was 9.8 days. Ideally, patients had a high likelihood of discharge towards 2010 as opposed to earlier periods. LOS also enjoyed a close association with economic factors. That is, LOS has reduced over time, with age, admission specialty, and deprivation sharing an independent association (Agboado et al., 2012).
Also, Polevoi et al. (2013) compared co-management with a traditional consultation to reduced LOS for patients under psychiatric care. They conducted a pre- and posttest study at an urban medical center with an outpatient unit from 2007 to 2009. The study subjects included a pool of adult patients reviewed as a danger to others and self. From a baseline perspectives, Polevoi et al. (2013) studied how resident psychiatrists evaluated patients and gave recommendations upon consultation.
The follow-up model, co-management, took effect in 2008 and included pharmacotherapy, monitoring, and appropriate disposition. The authors then used a time series analysis to help in studying the impact of the new model on LOS for patients. The secondary results included the hourly mean number of hours on ambulatory diversion as well as patients who left before attendance. Compared to the pretest stage, the median LOS for post-test patients decreased by about 22 percent. Particularly, the co-management has a close association with reduced LOS for these patients (Polevoi et al., 2013).
Now, as shown in the previous cases, twelve participants agreed to participate in this needs assessment. These individuals would initially respond to questionnaire items that asked questions based on closed and open-ended response over two weeks. In between these weeks was an educational intervention aimed at addressing the importance of reducing LOS/excess days. The resulted showed a general improvement in the view of education, teamwork, surveillance, and multidisciplinary performance as important elements to reduced LOS. There also existed a sharp increase in the view that increased socio-economic costs, nurse burnout, and decreased caregiver reputation as some of the primary concerns to increased LOS.
Particularly, the closed and open-ended questions tested on a precise and detailed take on LOS based on facility objectives, perception, experience, as well as LOS as an issue and concern. Based on the results in Table 1, 91 percent of the participants agreed that LOS was both an issue worth analysis. Out of these participants, 67 percent further agreed that their hospital lacked efficient practices to help in reducing LOS/ excess days. Finally, 83 percent viewed communication and experience as vital in the reduction of LOS (see the diagram 1 at the end of the essay).
The second intervention revealed a general improvement in the responses, all for a call towards reduced LOS/excess days. As shown in Table two, all respondents agree that LOS is a concern that affects both the hospital and its staff as well as patients. Moreover, a whopping 88 percent affirmed that experience among staff was vital in enhancing their approach towards LOS as applied to readmission rates. Lastly, about 90 percent reasoned that their respective departments lacked appropriate techniques required to improve care delivery while reducing LOS (see the diagram 2).
Chart 1 at the end of the essay is a combination of data from both surveys. The combined chart reveals variations in data for both surveys to determine the existence of a notable trend. Based on the data series, one would note a general trend improvement given different items. For instance, both questions one and three on LOS as a growing concern and an issue worth addressing have an upward trend in the response rate from eleven to twelve. That is, during the first survey, about 91 percent of the participants agree that LOS was an issue and growing concern. The second survey, however, depicts a hundred percent response for both items. Similar results are visible for questions 5 and 9 on the importance of nurse experience in reducing LOS and LOS as a negative factor in quality assessment, respectively. However, question 7 on the achievements made at facility level to enhance reduced LOS is also an improvement because it is has a negative connotation.
The trends have a positive effect the LOS/excess day’s reduction project. Ideally, they help identify some of the elements that would be vital in reducing LOS from a practical setting. For instance, it could help trying out education, teamwork, multidisciplinary communication, and patient surveillance as possible interventions that would help tackle the LOS issue. Interestingly, too, the needs assessment presented LOS as an issue worth a gradual change in the clinical setup.
As directed by van-de-Vijsel et al. (2015), such change projects would be vital when developing insight into the existence of any variation in LOS for hospitals over time. The idea is to find the need for efficiency and general service delivery improvement in healthcare. Van-de-Vijsel et al. (2015) studied the national admission data for Dutch hospitals between 1995 and 2010. They determined a significant difference in LOS as applied to changes in procedures and diagnoses over time. Also seen is the absence of hospital associated policies on LOS reduction. The authors concluded their research by making recommendations on EBP practices on efficiency improvement hence reduced LOS (van-de-Vijsel et al., 2015).
The assessment demonstrated an eventual improvement in hospital LOS and a drop in readmission rates should the facility consider the various ways of improving service delivery. The project suggests that as LOS reduced, hospital readmission and the socio-economic cost of care also reduced as long as the nursing staff follows the right procedures. The finding is vital because all factors play an important role as quality improvement indicators thus may result in improved hospital reputation. There, however, still exists a research gap in exploring the relationship between individual factors as tipping points for LOS or excess days. The study also limits its findings to one facility. Therefore, it would be essential to consider using a group of facilities to study the possible existence of an inter-facility variability (Bueno, et al., 2010).
Finally, there is new information concerning the basic fact that a reduction in LOS would reduce the risk of readmission through quality service delivery. Notably, this reduction could also increase the risk of more adverse events such as poor coordination and readmission as seen in ambulatory surgery settings. Thus, in the absence of facility-based surveillance system and quality of service improvement, such changes would result in increased readmission. As shown by Kaboli et al. (2012) there is still much to consider from the unknown if reduced LOS would bring about general positive changes to a facility and its patients. This new information should help in considering a more particular approach on the essential ingredients of the positive change allied reduced LOS.
References
Agboado, G., Peters, J., & Donkin, L. (2012). Factors influencing the length of hospital stay among patients resident in Blackpool admitted with COPD: a cross-sectional study. BMJ Open, 2 (5). doi:10.1136/bmjopen-2012-000869
Bueno, H. et al. (2010). Trends in Length of Stay and Short-term Outcomes Among Medicare Patients Hospitalized for Heart Failure, 1993-2006. Journal of the American Medical Association, 303(21), 2141-2147.
Kaboli, P., Go, J., Hockenberry, J., Glasgow, J., Johnson, S., Rosenthal, G., . . . Vaughan-Sarrazin, M. (2012). Associations Between Reduced Hospital Length of Stay and 30-Day Readmission Rate and Mortality: 14-Year Experience in 129 Veterans Affairs Hospitals. Annals of Internal Medicine, 157 (12), 837-845.
Polevoi, S., Shim, J., McCulloch, C., Grimes, B., & Govindarajan, P. (2013). Marked Reduction in Length of Stay for Patients with Psychiatric Emergencies after Implementation of a Co-Management Model. Society for Academic Emergency Medicine, 20 (4), 338-343.
van-de-Vijsel, A., Heijink, R., & Schipper, M. (2015). Has variation in length of stay in acute hospitals decreased? Analysing trends in the variation in LOS between and within Dutch hospitals. BMC Health Services Research, 15 (438). doi:10.1186/s12913-015-1087-6
