How Nurses Can Impact Length of Stay

Length Of Stay is an odd reimbursement metric.

It basically ignores the fact that each individual presumably heals at a different rate, and instead relies on the law of averages.

With reimbursement regulations like LOS due to stiffen, hospitals are scrambling to find better ways to comply. One way is to look at the many activities surrounding healing to determine if they can be done in less time.

Maria Romano knows a lot about time. For the past seven years she was the Patient Logistics Operational Manager at St. Peter’s Health Care Services in Albany, NY.

 

Part of her job was to pull as much wasted time out of the patient flow process as was humanly possible. To do that, she relied heavily on TeleTracking’s capacity management technology.

Maria, an RN with more than 20 years of experience, did quite well at that job, too. In fact, within a year, she and her team increased patient transfers from outside and inside the hospital by a stunning 450 percent. They also reduced ED wait time for an assigned bed from seven hours to less than 90 minutes.

Now, Maria is a TeleTracking product specialist with a focus on how our technology can shorten length of stay to comply with DRGs.

I had the opportunity to speak with her about her experiences. I share with you here some of her observations about nurses and LOS.

Nurses can have a huge impact on LOS by using available technology and being a better advocate for the patient, Maria believes.

• One obvious area is discharge. TeleTracking’s XT platform now provides discharge and transfer milestones, digital checklists which capture and time-stamp steps to be performed before a patient may leave the hospital. The checklist leaves a record of what went right and what went wrong in releasing a patient within a desired timeframe, providing a blueprint for fixing those problems.

• Another action involves alerting case management when outside issues (i.e., work schedules) preclude a timely pickup for a patient heading home.

• The Length of Stay column, which is linked to DRGs for a patient’s condition, allows staff to react to the possibility of an over-stay to determine what may be causing the discharge delay.

• Further upstream, LOS can be impacted by getting patients out of the ICU earlier if they are only being kept there for a physician’s convenience. It’s been estimated that half of all ICU patients could move to a step-down unit sooner because they no longer require continuous cardiac monitoring.

• Of course, anything a nurse can do to ward off the spread of infection can directly affect the LOS of not just one patient but several. TeleTracking’s Patient Placement Indicators see to it that isolation information is communicated to all who need to know when they need to know it. For example, housekeepers and transporters who might otherwise walk into a blocked room unaware that an infected patient was or had been there.

• ICU infection can be averted by adhering to ventilator-associated pneumonia and bloodstream infection bundles, maintaining unrelenting personal hand hygiene, and prompting all others entering a patient room to wash their hands.

• Nurses can also advocate for converting IV medications to oral drugs when appropriate, which will move patients along faster.

Implementing these changes can be a culture shock, which Maria also knows a great deal about.

“At St. Peter’s, the bed meeting was the golden cow, but we didn’t need it anymore with a patient flow automation system.  It was wasted time. So with TeleTracking providing best practice standards, I was able to discontinue it.”

“People came around to understanding why were doing things differently,” she says. “Once they truly understood that what I was doing was something good for our patients, they stopped avoiding me for coffee!”

Thank you, Maria!

What has been your experience managing length of stay? What role have nurses played?