System to decrease length of stay for vascular surgery.
OBJECTIVE
Reduction of length of stay (LOS) is critical for optimal use of hospital resources. We developed and evaluated a system to aggressively reduce LOS for vascular surgery.


METHODS
Key to this system, which we introduced on January 1, 2001, was appointment of a LOS officer, who communicated daily during hospitalization with patients and families about discharge planning, organized outpatient services for wound care and rehabilitation to transition patients quickly to nonhospital care, and had biweekly meetings with relevant paramedical services. LOS for 509 patients operated on in 2000 (standard group) was compared with LOS for 474 operated on in 2001 and 595 patients operated on in 2002 (LOS reduction groups). Data for all patients with aortic aneurysm, carotid artery stenosis, lower extremity critical ischemia or amputation, and foot debridement were included.


RESULTS
LOS in 2000 averaged 8.5 days, compared with 5.9 days in 2001 and 5.6 days in 2002. All decreases in LOS for each diagnostic category in 2001 and 2002 were statistically significant (P = <.001-.03). There was no significant increase in readmission rate (2.2% vs 1.9% and 2.0%, respectively), mortality rate (0.8% vs 0.6% and 0.7%, respectively), or percent of patients who received endovascular treatment (18% vs 16% and 14%, respectively). These decreases in LOS saved the hospital more than US dollars 616200 in 2001, and US dollars 847550 in 2002 (US dollars 500/patient-day).


CONCLUSIONS
A committed LOS officer with major specific daily responsibilities for decreasing LOS and discharging patients resulted in a 31% to 33% decrease in LOS, with important cost savings to the hospital and no negative effect on patient care.
Reed
Taylor
T
Division of Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine New York, NY 10467, USA.
Veith
Frank J
FJ
Gargiulo
Nicholas J
NJ
Timaran
Carlos H
CH
Ohki
Takao
T
Lipsitz
Evan C
EC
Malas
Mahmoud B
MB
Wain
Reese A
RA
Suggs
William D
WD
D000368:Aged; D003363:Cost Control; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D010564:Personnel, Hospital; D013997:Time Factors; D014656:Vascular Surgical Procedures