Early and Direct Rehab Transfer Leads to Significant Cost Savings and Decreased Hospital Length of Stay for Total Joint Arthroplasty in a Veteran Population

2021 ◽  
Author(s):  
Kelly R. Stiegel ◽  
Matthew T. Valentine ◽  
Jonathan G. Lash ◽  
Justin M. Cardenas ◽  
Melvyn A. Harrington ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Joint Arthroplasty ◽  
Cost Savings ◽  
Hospital Length ◽  
Joint Arthroplasty ◽  
Hospital Length Of Stay ◽  
Significant Cost

The Association Between Hospital Length of Stay and 90-Day Readmission Risk Within a Total Joint Arthroplasty Bundled Payment Initiative

2017 ◽  
Vol 32 (3) ◽  
pp. 714-718 ◽  
Author(s):  
Jarrett Williams ◽  
Benjamin S. Kester ◽  
Joseph A. Bosco ◽  
James D. Slover ◽  
Richard Iorio ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Joint Arthroplasty ◽  
Hospital Length ◽  
Joint Arthroplasty ◽  
Hospital Length Of Stay ◽  
Bundled Payment ◽  
Readmission Risk

scholarly journals Improving Hospital Length of Stay: Results of a Retrospective Cohort Study

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 762
Author(s):  
Swapnil Patel ◽  
Abbas Alshami ◽  
Steven Douedi ◽  
Natasha Campbell ◽  
Mohammad Hossain ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Medical Center ◽  
Waiting Times ◽  
Cost Savings ◽  
Primary Outcome Measure ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Process ◽  
Root Cause ◽  
Rehabilitation Facilities

(1) Background: Jersey Shore University Medical Center (JSUMC) is a 646-bed tertiary medical center located in central New Jersey. Over the past several years, development and maturation of tertiary services at JSUMC has resulted in tremendous growth, with the inpatient volume increasing by 17% between 2016 and 2018. As hospital floors functioned at maximum capacity, the medical center was frequently forced into crisis mode with substantial increases in emergency department (ED) waiting times and a paradoxical increase in-hospital length of stay (hLOS). Prolonged hLOS can contribute to worse patient outcomes and satisfaction, as well as increased medical costs. (2) Methods: A root cause analysis was conducted to identify the factors leading to delays in providing in-hospital services. Four main bottlenecks were identified by the in-hospital phase sub-committee: incomplete orders, delays in placement to rehabilitation facilities, delays due to testing (mainly imaging), and delays in entering the discharge order. Similarly, the discharge process itself was analyzed, and obstacles were identified. Specific interventions to address each obstacle were implemented. Mean CMI-adjusted hospital LOS (CMI-hLOS) was the primary outcome measure. (3) Results: After interventions, CMI-hLOS decreased from 2.99 in 2017 to 2.84 and 2.76 days in 2018 and 2019, respectively. To correct for aberrations due to the COVID pandemic, we compared June–August 2019 to June–August 2020 and found a further decrease to 2.42 days after full implementation of all interventions. We estimate that the intervention led to an absolute reduction in costs of USD 3 million in the second half of 2019 and more than USD 7 million in 2020. On the other hand, the total expenses, represented by salaries for additional staffing, were USD 2,103,274, resulting in an estimated net saving for 2020 of USD 5,400,000. (4) Conclusions: At JSUMC, hLOS was found to be a complex and costly issue. A comprehensive approach, starting with the identification of all correctable delays followed by interventions to mitigate delays, led to a significant reduction in hLOS along with significant cost savings.

Intervention to Discontinue Parenteral Antimicrobial Therapy in Patients Hospitalized with Pulmonary Infections: Effect on Shortening Patient Stay

1992 ◽  
Vol 13 (1) ◽  
pp. 21-32 ◽  
Author(s):  
N. Joel Ehrenkranz ◽  
Debra E. Nerenberg ◽  
James M. Shultz ◽  
Kenneth C. Slater
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Cost Savings ◽  
Severity Of Illness ◽  
Cost Effective ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Patient Specific ◽  
Practice Characteristics ◽  
Alternative Drug

AbstractObjectives:Current efforts to contain antimicrobial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stayMethods:A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians withnonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials. Blinded observers evaluated in-hospital and30-day postdischarge courses of patients of physicianswhohad been contacted by the nurse (cases) and those who had not (controls).Results:Eighty-two patient episodes (47 physicians) met study criteria. There were 53 cases and 29 controls. In 42 of 53 (79%) case episodes, physicians discontinued parenteral antimicrobials; patients' mean length of stay was 2.4 days less than for 29 control episodes (estimated cost savings was$884/patient). In 11 (21%) episodes, case physicians continuedparenteraltherapy; patients' mean length of stay was 1.9 days longer than for controls (estimated cost excess was$704/patient). Education, training and practice characteristics were comparable in physician groups. Severity of illness indicators and postdischarge outcomes were comparable in patient groups.Conclusions:The major cost-saving potential for shifting from par-enter-al to oral antimicrobial therapy is shortened length of stay. Timely information about alternative drug therapies, offered on a patient-specific basis, appears to modify the treating behavior of physicians. The program as currently conducted is cost-effective, with an estimated net savings of $50,000 per 100 interventions.

Improving postoperative mobilisation rates in patients undergoing elective major hepatopancreatobiliary surgery

2020 ◽  
pp. postgradmedj-2020-138650
Author(s):  
Jun Han Tang ◽  
Bei Wang ◽  
Jie Ling Jaclyn Chow ◽  
Priscilla M Joseph ◽  
Jia Ying Chan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Quality Improvement Intervention ◽  
Early Mobilisation ◽  
Potential Cost ◽  
Improvement Project ◽  
Pareto Chart

BackgroundEarly mobilisation reduces postoperative complications such as pneumonia, deep vein thrombosis and hospital length of stay. Many authors have reported poor compliance with early mobilisation within Enhanced Recovery After Surgery initiatives.ObjectivesThe primary objective was to increase postoperative day (POD) 2 mobilisation rate from 23% to 75% in patients undergoing elective major hepatopancreatobiliary (HPB) surgery within 6 months.MethodsWe report a multidisciplinary team clinical practice improvement project (CPIP) to improve postoperative mobilisation of patients undergoing elective major HPB surgery. We identified the common barriers to mobilisation and analysed using the fishbone or cause-and-effect diagram and Pareto chart. A series of Plan–Do–Study–Act cycles followed this. We tracked the rate of early mobilisation and mean distance walked. In the post hoc analysis, we examined the potential cost savings based on reduced hospital length of stay.ResultsMobilisation rate on POD 2 following elective major HPB surgery improved from 23% to 78.9%, and this sustained at 6 months after the CPIP. Wound pain was the most common reason for failure to ambulate on POD 2. Hospital length of stay reduced from a median of 8 days to 6 days with an estimated cost saving of S$2228 per hospital stay.ConclusionMultidisciplinary quality improvement intervention effort resulted in an improved POD 2 mobilisation rate for patients who underwent elective major HPB surgery. This observed outcome was sustained at 6 months after completion of the CPIP with potential cost savings.

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