Are reductions in emergency department length of stay associated with improvements in quality of care?

"We sought to determine whether patients seen in hospitals who had reduced overall emergency department (ED) length of stay (LOS) in the 2 years following the introduction of the Ontario Emergency Room Wait Time Strategy were more likely to experience improvements in other measures of ED quality of care for three important conditions."

Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis
MJ Vermeulen et al.
BMJ Qual Saf 2016;25:489-498 doi:10.1136/bmjqs-2015-004189

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Unbundling recovery: A step-by-step guide to audit and modelling

"This practical guide sets out a methodology for providers to audit whether the recovery aspects of a patient's acute hospital stay could be better provided and to model the impact of varying lengths of stay on tariff and bed utilisation."

Unbundling recovery: A step-by-step guide to audit and modelling
NHS Improving Quality
June 2015

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Implementing the NICE guideline on Transition between inpatient hospital settings and community or care home settings for adults with social care needs

"Overall, it is expected that implementing the guideline will be cost saving. Implementing the guideline is likely to have resource implications (both costs and savings) for health and social care commissioners and for providers"

Implementing the NICE guideline on Transition between inpatient hospital settings and community or care home settings for adults with social care needs (NG27) 
NICE (Costing statement)
December 2015

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Improving length of stay: what can hospitals do?

"This report on length of stay by the Nuffield Trust is part of a larger project undertaken by Monitor which aims to find the best ways to improve quality of care across the health system in light of recent pressures on urgent and emergency care."
Improving length of stay: what can hospitals do?
N Edwards, R Lewis Nuffield Trust
September 2015

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The Impact of Primary Care Quality on Inpatient Length of Stay for People with Dementia

"For those who are discharged home or to the community setting, the QOF review may have a small negative influence on length of stay. Such modest effects suggest that the QOF review does not have a major influence on LoS for dementia hospital admissions. However, this does not mean the review is unimportant for patient care: the increasing prevalence of dementia and the constraints on capacity in the acute hospital sector may mean even modest impacts are important financially. "

The Impact of Primary Care Quality on Inpatient Length of Stay for People with Dementia: An Analysis by Discharge Destination
P Kasteridis, M Goddard, R Jacobs, R Santos, A Mason
CHE Research Paper 113
Centre for Health Economics, University of York, UK

July 2015

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Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay

"A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS [length of stay] of inpatients awaiting social packages and placement."

Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay: A Quality Improvement Project
A Shabbir, G Wali, A Steuer
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208974.w3661

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Enhanced recovery clinical education programme improves quality of post-operative care

"The Enhanced Recovery (ER) clinical education programme improved quality of post-operative care, leading to reduced length of stay with no increase in 28 day readmission rates."

Enhanced recovery clinical education programme improves quality of post-operative care
R McDonald
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208370.w3387

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5 basic hospital inefficiencies and their quick fixes

"Although many of the issues that lead to inefficiency may be complex, there are still some quick fixes that can add up to huge savings in both staff time and money. Here are some of the most common hospital inefficiencies and some simple strategies that can help to correct them"

5 basic hospital inefficiencies and their quick fixes
J Henry
Healthcare Dive
February 2015

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To reduce the average length of stay of patients who are admitted for DA-EPOCH-R chemotherapy regimen

"A quality improvement project was initiated to review and revise the workflow and processes involved for the entire episode of treatment. A post-implementation review of the interventions showed cost savings, a reduction of average length of stay from seven days to six days (with a total of 28 days saved over six months), and improved patient and staff experience."

To reduce the average length of stay of patients who are admitted for DA-EPOCH-R chemotherapy regimen
Y M Lee
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208379.w3434

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The cost of hospital-acquired complications for older people with and without dementia

"Increased length of stay and high rates of adverse clinical events in hospitalised patients with dementia is stimulating interest and debate about which costs may be associated and potentially avoided within this population."

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study

K Bail, J Goss, B Draper, H Berry, R Karmel, D Gibson
BMC Health Services Research 2015, 15:91  doi:10.1186/s12913-015-0743-1

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Reducing pre-operative length of stay for enterocutaneous fistula repair with a multi-disciplinary approach

"We started this project with the aim of reducing the pre-operative length of stay for assessment of complex surgical patients in a tertiary-referral centre. Through the instigation of a weekly multi-disciplinary team meeting and a formalised patient pathway including referral process, we have demonstrated a reduction in length of stay from 30.1 to 5.7 days that would result in an annual saving of over £177,000 on bed-day costs alone."

Reducing pre-operative length of stay for enterocutaneous fistula repair with a multi-disciplinary approach
M Chamberlain, R Dwyer
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204075.w1773

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Senior staff cover means earlier discharges

"Patients admitted to A&E in the evening can stay in hospital up to four days longer than those admitted in the morning. To reduce their stays, trusts can take targeted action during the assessment phase"

Senior staff cover means earlier discharges
S McGirr, A Mullarkey, S Graham, R Sowney, R Emeny, V Connolly
Health Service Journal, June 2014

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Safely and effectively reducing inpatient length of stay

"While various interventions have been proposed to improve the efficiency and quality of inpatient care, with inconsistent results when rigorously evaluated, the General Internal Medicine Care Transformation Initiative did decrease length of stay for hospitalised GIM patients above and beyond existing secular trends in teaching hospitals without increasing post-discharge adverse events."

Safely and effectively reducing inpatient length of stay: a controlled study of the General Internal Medicine Care Transformation Initiative
FA McAlister, JA Bakal, SR Majumdar, S Dean, RS Padwal, N Kassam, M Bacchus, A Colbourne
BMJ Quality and Safety, 2014; 23: 446-456

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Increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections

"Bloodstream infections are associated with an increased risk of death and longer hospital stay. Avoiding infections could save lives and free up valuable bed days."

The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case–control study
AG Barnett, K Page, M Campbell, E Martin, R Rashleigh-Rolls, K Halton, DL Paterson, L Hall, N Jimmieson, K White, N Graves
BMJ Open, 2013, 3:e003587

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Time to act: severe sepsis: rapid diagnosis and treatment saves lives

"Better care could lead to savings in 8 Time to act - Severe sepsis: rapid diagnosis and treatment saves lives terms of reduced length of hospital stay and less intensive care and renal dialysis."

Time to act: severe sepsis: rapid diagnosis and treatment saves lives
Parliamentary and Health Service Ombudsman
September 2013

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Elective hospital admissions, waiting times and patient experience

"This Briefing will help non-executive directors (NEDs) better understand NHS data and how it can be used to determine what is going on in their hospital."

The non-executive directors' guide to hospital data: Part two: Elective hospital admissions, waiting times and patient experience
Hospitals Forum briefing
NHS Confederation
May 2013, Issue 263

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Reducing unnecessary hospital days to improve quality of care through physician accountability

"Results indicate that a strategy, involving physician direct accountability, can reduce unnecessary hospital days."

Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial
C Caminiti, et al.
BMC Health Services Research, 2013, 13:14

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Delay in discharge and its impact on unnecessary hospital bed occupancy

"Elderly patients experiencing acute surgical admission and discharge to community hospitals had prolonged length-of-stay due to significant delays associated with care of the elderly provision."

Delay in discharge and its impact on unnecessary hospital bed occupancy
Majeed MU, et al.
BMC Health Services Research, 2012, 12:410

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Older people and emergency bed use

"There is significant variation in the use of hospital beds by people over 65 admitted as an emergency."

Older people and emergency bed use: exploring variation
C Imison, E Poteliakhoff, J Thompson
The King's Fund
August 2012

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English hospitals can improve their use of resources

"The findings suggest that all hospitals have scope to make efficiency savings in at least one of the clinical areas considered by this study."

English hospitals can improve their use of resources: an analysis of costs and length of stay for ten treatments
CHE Research Paper 78
J Gaughan, A Mason, A Street, P Ward
Centre for Health Economics, University of York
July 2012

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