Safely decreasing length of stay (LOS) and improving throughput is an important metric for any Hospitalist program.
We don’t need to go into all the reasons why (but feel free to read here: NCBI analysis of LOS).
There are lots of factors that impact your patient length of stay and throughput and one important factor that can often get overlooked is your patient assignment process.
If you’re currently using pen and paper, Excel spreadsheets, or making lots of manual moves in your EHR to create your daily rounding list, then it’s difficult to take into account things like:
- Evenly balancing physician workloads
- Ensuring no physicians are overloaded with New Admits or Discharges
- Evenly balancing geography while also preserving continuity of care
It’s virtually impossible to take all these different scenarios into account when you’re creating rounding lists manually. And that can significantly increase your patients’ length of stay, and decrease throughput.
That’s why we developed our Assign solution, which automates the patient assignment process, based on the factors that are important to you. If reducing length of stay and improving throughput is a metric your team wants to improve, here’s how Assign can help.
Thinking Differently About How You Calculate Length of Stay
First, we need to consider how LOS is calculated. Typically, LOS is calculated by patient admit date and time minus discharge date and time. This raw data can be misleading. Medaptus Assign is primarily focused on the patient’s journey within the hospitalist group. What if the patient is transferred to the ICU and back several times? Goes for Surgery? There are several factors that will reflect a longer LOS by using this simple calculation described above.
We can certainly show you before and after examples from our clients that have seen an improved LOS by using this raw data, but I think it would be more important to illustrate what features we have within our software that improve LOS. These features are what our clients have told us were nearly impossible to maintain manually on a consistent basis.
Within medaptus, we believe the strongest correlation to lowering LOS and improving throughput is limiting the amount of attending providers responsible for care during a patient’s stay. We have seen several scenarios in which a patient is seen by 3 or 4 different Hospitalists over the course of their visit, due to:
- Geography changes
- Upgrade to ICU and then downgrade
- Physician schedules
What if you could take those scenarios into account during your patient assignment process, preserve continuity of care, and reduce the number of providers a patient sees? This is one of the most important ways to decrease length of stay and improve hospital throughput, and what Assign does.
Here is how we directly accomplish this:
Continuity of Care – Previous Day: Medaptus stores continuity of care for each provider in our system. If a provider saw the patient yesterday, they will get the patient back today. Some form of this rule is used universally with all of our clients.
Continuity of Care – Previous Admission: Giving a patient back to a provider they saw during a previous admission is very challenging to track manually. Medaptus can track previous admission assignments up to 120 days. This provider has a previous relationship with the patient so it makes sense to assign them back.
Succession (AKA Sign out or handoff) rules: Hand-off days are some of the most challenging to manage. As one group of providers goes off shift, a new group comes on. Medaptus has the ability to hand off patients from one provider to the next based on your schedule. This makes for a smooth transition of patient care.
Dedicated Teams: OBS, ICU, and Teach are just some examples of dedicated teams we can automatically create for you. This allows you to easily group and manage patients based on the provider team. This consistently keeps specific patients on specific rounding lists each day.
Balanced Physician Workloads
Within medaptus, we also believe balanced physician workloads directly result in more efficient rounding, better discharge ratios, and overall happier providers. When physician workloads are more evenly balanced, they can discharge patients on time, improve throughput, and reduce avoidable days, which can cost anywhere between $500-2,000/patient. Imagine if each of your providers had one avoidable day per week and how much that would save alone!
Here is how we directly accomplish this:
Evenly balance rounding list by headcount: You can choose to ensure that each provider has the same number of patients as every other provider that day (keeps providers happy and reduces complaints).
Evenly balance rounding lists by weighted workload: Often evenly balancing by headcount isn’t enough. Even if providers all have the same number of patients, they may not be equal amounts of work. Medaptus can weight-specific patient types (such as New Admits, ICU Downgrades, etc.) so all your physicians get a similar workload (and not just the same number of patients). Another challenge we’ve heard from hospitalists is about the “Discharge Tax” they pay if they discharge too many patients one day, and then receive all new admits the next day. We can help you balance these types of patients with other options, to not penalize providers that had higher discharges the day prior.
Evenly distribute specific patient types with higher acuity: There are certain patient types that are more “work” than others. New Admissions and Unseen patients are two of the most popular types that hospitals try to evenly distribute among their doctors. Medaptus can do this automatically for you by using our rules logic. We will work with you on identifying the criteria of the patients you want to evenly distribute. We can ensure that all your hospitalists get an even amount of these specific patient types (so no doctor will receive four New Admits, while another hospitalist receives only one that day). By doing so, you can maintain an even workload in terms of headcount (same number of patients per provider) while also distributing an equal number of patients with certain attributes.
Geographical rounding lists: Keeping a provider within a certain geographic region is something most hospitalist programs want to accomplish but find very difficult to do manually with a fluctuating census.
Geographical succession rules: Typically, by the end of a provider’s weekly schedule, their rounding lists consists of patients spread out throughout the hospital. Medaptus can incorporate geographical succession rules – a geographical subset of patients can be handed off to the next provider. This gives the next provider a more localized list to start with.
Analyzing Your Hospitalists’ Benchmarks
Finally, the last area that’s important to mention is that since patient length of stay can be impacted by many factors, some of our clients like to specifically look at hospitalists’ average length of stay as compared to other hospitalists.
It’s difficult to measure this when you’re creating patient lists manually. Our standard reports allow you to drill down into the average LOS at your facility and look at LOS per provider, too. This will allow you to better analyze why some hospitalists may be discharging more or less frequently, and the reasons why, so you can correct them and improve your overall LOS rates.
