Reducing inpatient length of stay can significantly improve care quality and access, patient outcomes and organizational performance. In 2016, NYC Health + Hospitals/Jacobi implemented a project to decrease inpatient medicine length of stay, aiming to initiate daily interdisciplinary team rounding to achieve a sustained decrease of 0.5 days in this crucial metric.
To start, executive leadership engaged the Lean/Breakthrough department to facilitate a more efficient discharge process. A multidisciplinary team with representation from all relevant services evaluated the initial state, identified barriers and set goals. The first step in this continuous improvement process was standardizing interdisciplinary team rounds, including the development of a rounding tool. The rounds generated a forum where everyone’s voice and creative ideas were heard, leading to more efficient processes, a shared mental model and enhanced safety culture. Lean/ Breakthrough staff consistently aided in troubleshooting challenges and identifying barriers, thus ensuring sustainability.
From 2016 to 2018, the facility achieved a sustained reduction of 0.84 days in length of stay, with a concomitant increase in the number of discharges from 477 to 582. Today, 100% of inpatient medicine patients are attended to through rounds on a daily basis, leading to more timely discharges. The program has been sustained for 25 months.
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