Dear Colleagues:
Length of stay continues to be a top priority. Given the difficult climate of health care finances and recent news of increased insurance premiums, we must remain vigilant and committed to keeping costs in check, and reducing length of stay is an achievable target in our efforts. At BWH, it becomes paramount as our inpatient capacity will not increase until 2008, meaning a reduction in LOS is the only way to increase volume in the next two years.
For this fiscal year, average length of stay (ALOS) through July is slightly above last year’s levels and above what we projected for this year’s budget. However, length of stay does not tell the entire story, as the complexity and acuity of our patients this year are above last year’s levels. Overall through July, our ALOS excluding newborns is 5.43 days, or 1.9 percent above last year’s levels at this time, but our case mix index (CMI) is up 3.7 percent.
There is good news, when CMI is used to calculate our observed versus expected (O/E) LOS ratio using the University Health Consortium database. For the third quarter of fiscal year 2006, for example, our O/E LOS was .95 or 5 percent better than our peer academic medical centers. Importantly, we have been able to improve on this metric from 1.05 to 0.95 over the last 4 years.
While the news around our LOS efforts is relatively positive given the complexity of our patients, it illustrates our need to adhere to and improve our strategies of reducing LOS. We have a robust strategy in place to take advantage of our relationship with Partners extended care facilities, like Spaulding Rehabilitation Hospital for significant rehabilitation for strokes and complex or multiple joint replacements, or after acute illness, and Youville Hospital and Rehabilitation Center for complex medical and surgical patients.
The BWH Addiction Psychiatry Service (APS), also known as the ACE Team, provides substance abuse consultation and educational services to clinicians for medical, surgical, and ob/gyn inpatients and outpatients, including those in the ED. These consultations can play an integral role in managing a patient’s plan of care and cut down on a patient’s stay.
And we have a task force looking at certain patient subsets in our cardiovascular services, such as patients on ventricular assist devices or IV therapies. With the right support in place, there is potential for transitioning some of these patients to other facilities or home sooner, as long as their care can be appropriately managed.
The underlying theme for our efforts to reduce LOS is delivering appropriate care to our patients efficiently. We’re likely to grapple with this issue for some time, and the dialogue will continue among BWH leadership from divisions and departments to the COO and hospital president. If you have any ideas and input, please join this conversation.