In January 2021, TeamHealth’s hospital medicine service line began a robust length of stay (LOS) pilot project, spearheaded by the Length of Stay Committee, to determine proof of concept for the TeamHealth LOS Program. The project’s aim was to determine if the implementation and execution of the TeamHealth Hospital Medicine Length of Stay (LOS) program will improve LOS while simultaneously maintaining quality metrics. The research team utilized a prospective cohort study to collect data over a 24-month period (12 months pre-implementation and 12 months post-implementation) to determine if there was a statistically significant improvement in LOS and secondary quality measures.
A Piloted Approach to LOS
The two-year pilot project is robust in content and creation. With an impressive set of tools at their disposal, the team leveraged various data platforms and resources. Clinical teams are provided a robust toolkit and roadmap and the ability to choose the tactics and tools most helpful for their individual facilities and needs. The roadmap begins with identification of facility-specific opportunities for improvement and then leads to a collection of over five dozen individual best practices, as well as resources to support implementation of those best practices.
Identifying Opportunities
The project’s roadmap begins with a self-assessment questionnaire available to clinicians on TeamHealth’s intranet application, Zenith, on the HM LOS Program channel. The self-assessment allows clinicians to gauge their facility’s current LOS performance and provide a baseline. From there, clinicians identify areas of high and low performance, choosing the opportunities for greatest improvement. This tool can also be used for ongoing reevaluation. Questions focus on key areas like existing LOS data access at the facility, current processes and more, in order to identify gaps.
Implementing Custom Solutions
After the self-assessment, clinicians utilize the LOS toolkit, which is divided into sections with multiple tactics designed to address each of the major areas that contribute to inefficient throughput. The roadmap encourages clinicians to incorporate a variety of tactics to ensure both short-term and long-term improvements in LOS management. In addition, supplementary action plans, newsletter resources and leadership tools provide support for communication and planning. Leveraging different platforms, such as custom dashboards, facility medical directors access their specific facility data to best address their needs when selecting tactics.
Soliciting Feedback
The LOS Committee is dedicated to continuous improvement of the project, resources and communication to best meet the needs of front-line clinicians. Structured check-ins during the pilot phase solicited feedback to create more accessible information and plans for implementation. This ensured that the project was robust and structured when moving out of the pilot phase and rolling out across facilities nationwide.
“Using the LOS channel as an FMD was easy to navigate and extremely informative. I liked the way I was able to focus in on the areas of LOS improvement that would work best for my program by taking the LOS self-assessment. I found so much information in the LOS toolkit that it was a little daunting at first, but once I looked at the specific areas that would apply to my facility, I felt it gave me so much knowledge to work with and succeed.” – Dr. Victoria Grasso
The Results
With two years of data, from the pre-implementation to post-implementation phases, the pilot project has shown great success in reducing LOS without negatively impacting other quality metrics. The pilot study encompassed four facilities across the Southeast and Northeast United States. Collective and specific results per facility from tactic implementation in October 2022 included:
- The mean LOS across all facilities reduced from 4.58 days to 4.37 days after implementation
- Mortality rates decreased where measured during the post-implementation phase from 0.9 to 0.8
- HCAHPS increased where measured from the pre-implementation to post-implantation phases
- Each facility in the pilot project experienced decreased ALOS:
- Facility 1 decreased from 5.44 to 5.28
- Facility 2 decreased from 3.74 to 3.50
- Facility 3 decreased from 4.68 to 4.38
- Facility 4 decreased from 4.47 to 4.37
The Conclusions
The TeamHealth Hospital Medicine LOS Program is patient-centric and provides support for our hospital medicine teams and our hospital partners to remove barriers, improve inefficiencies, and improve patient care. TeamHealth is raising the level of performance in hospital medicine and across the continuum of care. Three years in the making from the best minds in hospital medicine, the LOS pilot project is an example of sophistication in clinical services that elevates the standards of healthcare delivery. Reach out to our team to learn how we can help your facility or health system.
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