ED Cuts LOS by 30 Minutes
In an initiative that began last fall, the Emergency Department (ED) has cut the average length of stay (LOS) for all patients by nearly 30 minutes—the equivalent of adding 3.3 new ED beds.
The initiative began in October in response to a spike in overcrowding associated with ever increasing patient acuity and a high inpatient census, resulting in a greater number of hospital inpatients boarding in the ED. “At certain times of day, we know that there will be many more ED patients than we have space for,” Joshua Kosowsky, MD, associate clinical director for the ED, said. “We wanted to focus on LOS because it is one of the variables that we have some degree of control over, particularly when it comes to discharged patients.”
Doing so required the ED leadership to redeploy nursing and physician staff during peak hours, improve throughput efficiency and heighten awareness among all ED staff of the need to drive down LOS as a key quality initiative.
“Overcrowding can be predicted to a certain degree,” Kosowsky said. Typically, the ED experiences a rush of patients from mid-day on. After reviewing the data, ED leadership augmented and reallocated nursing staff to match peak patient demand and added attending physician coverage.
The ED’s tracking system proved a major factor in cutting LOS. “We have always been attentive to LOS, but this time we asked our staff for—and got—intense focus, keeping at it minute by minute in the ED,” said Stephen Bohan, MD, clinical director and vice chair of Emergency Medicine. “While it was hard work, this effort was made easier by the brilliant, home-grown tracking system.”
Over six months, the ED reached its goal of decreasing LOS by a half hour per patient, which allows it to accommodate 18 more patients a day—the equivalent of adding 3.3 beds to the ED.
“This length-of-stay initiative is the centerpiece of our transitional plans to help BWH to continue to grow volume as we plan for a higher capacity ED in the near future,” said Ron Walls, MD, chair of the Department of Emergency Medicine.