title: Fast-tracking acute hospital care--from bed crisis to bed crisis.
abstract: We describe here the results of a continuous quality improvement (CQI) project, the Delayed Discharge Project, in a general medicine service in a New Zealand teaching hospital. Average length of stay (ALOS) dropped by 2.6 days (6.5 to 3.9), readmission rates did not rise, costs of service delivery dropped by US dollars 2.4 million, patient numbers increased by 145 (2445 to 2590), while bed numbers reduced from 56 to 32 and ward outliers all but disappeared, suggesting success. However, 2 years after the successful cost-saving measures were introduced the new system crashed as a result of additional bed closures and organisational restructures.
authors.affiliation: Otago District Health Board, Clinical Leader, Internal Medicine, Otago District Health Board, Private Bag 1921, Dunedin 9016, New Zealand. BrendonR@healthotago.co.nz
authors.forename: Brendon
authors.initials: B
authors.lastname: Rae
authors.forename: Wendy
authors.initials: W
authors.lastname: Busby
authors.forename: Peter H
authors.initials: PH
authors.lastname: Millard
mesh_terms: D000368:Aged; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D005853:Geriatrics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity; D017721:Hospital Costs; D006748:Hospital Departments / Q000458:organization & administration / Q000706:statistics & numerical data*; D006754:Hospital Restructuring; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D009520:New Zealand; D009936:Organizational Innovation; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000639:trends; D017749:Total Quality Management / Q000458:organization & administration*