Numerous factors contribute to a long length-of-stay. Evidence for hospital-wide strategies reducing the duration of admissions is limited. These patients often require more time and resources than more routine cases. Our hospital identified these patients as a unique challenge to our unit-based medical, case management, and social work interdisciplinary teams.
The Enhanced Interdisciplinary Care Team (EICT) was formed to identify patients at risk for prolonged hospitalizations or complex post-acute care needs and to develop solutions to reduce length of stay and facilitate discharge to the appropriate level of care.
The EICT consists of a hospitalist, case manager, and social worker with close support from respective department leadership. The EICT screens patients hospital-wide and serves as a longitudinal, consultative service to the primary medical and surgical teams. Various screening mechanisms for EICT were vetted to identify patients expeditiously, including the need for intensive care and those who were approaching end-of-life. Interventions were tailored to patient’s preferences and clinical appropriateness.
The implementation of the EICT has led to a significant reduction in the proportion of patients who were length of stay outliers, defined as an observed to expected length of stay (O:E LOS) of greater than 1.5. Over six months, there was a total reduction of 1,099 patient-days among patients with an O:E LOS > 1.5 from the pre-intervention period. This decrease corresponds to a total of 275 virtual discharges.
A structured interdisciplinary care team dedicated to patients at risk for prolonged hospital admission was associated with improvements in various length of stay metrics. We identified common clinical presentations and intervention strategies, such as long-term acute care hospitals for weaning from ventilator; complex home discharges for patients with poor access to healthcare; facilitation of goals of care for patients at the end of life; and long-term placement of elderly patients with dementia and behavioral disturbances but without psychiatric diagnoses.
Implications for the Patient
The care of patients with common but difficult clinical presentations, e.g., end-of-life, prolonged ventilator requirement, or end-stage dementia, is challenging and has demonstrable broader systemic implications. The EICT identified these patients early and was able to use unique expertise to expedite discharges to appropriate levels of care.