Reppond Alexander M, Flavin Nicholas, Albaum Michael N
Department of Operations Transformation, MaineHealth, Portland, Maine.
Department of Quality Reporting & Data Analysis, MaineHealth, Portland, Maine.
J Maine Med Cent. 2024 Summer;6(2). doi: 10.46804/2641-2225.1197.
Average length of stay (ALOS) has increased in many US hospitals in the post-COVID-19-pandemic world. We undertook a process improvement initiative to reduce the ALOS in our community hospital.
Three core tactics were developed with a goal of reducing our ALOS by 10%. These tactics were early mobilization, Interprofessional Partnership to Advance Care and Education rounding, and structured interdisciplinary care rounds. Workgroups in each of these domains designed the improvement, devised measures of success, and implemented the tactic. A process improvement specialist worked with each workgroup using elements of the Model for Improvement. Process measures were reported weekly. Outcome measures (ALOS, observed vs expected LOS) were reported weekly. A central steering committee oversaw the initiative. All tactics were fully implemented by February 2023.
For the first 6 months after implementing our tactics, the ALOS on our inpatient medical units decreased from 6.3 to 5.5 days (13.7%) when compared with the same 6-month period in the prior year (P < .01).
We used 3 interventions to impact the ALOS in our community hospital. Preliminary data show a significant improvement. We cannot isolate the independent contribution of each intervention and did not control for confounders.
Our interdisciplinary team developed and implemented tactics to reduce the ALOS in our community hospital by 13.7%.
在新冠疫情后的世界里，美国许多医院的平均住院时长（ALOS）有所增加。我们开展了一项流程改进计划，以缩短我们社区医院的平均住院时长。
制定了三项核心策略，目标是将我们的平均住院时长降低10%。这些策略包括早期动员、跨专业推进护理与教育查房伙伴关系以及结构化跨学科护理查房。每个领域的工作组设计改进方案、制定成功指标并实施该策略。一名流程改进专家运用改进模型的要素与每个工作组合作。每周汇报流程指标。每周汇报结果指标（平均住院时长、观察到的与预期的住院时长）。一个中央指导委员会监督该计划。所有策略在2023年2月前全部实施。
在实施我们的策略后的前6个月，与上一年同期相比，我们内科住院单元的平均住院时长从6.3天降至5.5天（下降了13.7%）（P < .01）。
我们采用了3种干预措施来影响我们社区医院的平均住院时长。初步数据显示有显著改善。我们无法分离每种干预措施的独立作用，也未对混杂因素进行控制。
我们的跨学科团队制定并实施了策略，将我们社区医院的平均住院时长降低了13.7%。
