title: Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit.
abstract: BACKGROUND
  Optimizing hospital operations is a critical issue facing healthcare systems. Reducing unnecessary variation in patient flow is likely to improve efficiency and optimize capacity for hospital inpatients. The objective of this study was to determine whether changing admissions, from a "bolus" system to a "drip" system, would result in a smoothed daily discharge rate, and reduce the length of stay of patients on a General Internal Medicine clinical teaching unit over a period of 1 year.
  
  
  METHODS
  We conducted a retrospective analysis of the General Internal Medicine inpatient service at Toronto General Hospital for the 6-month periods from March to August during 2 consecutive years. Length of stay distributions and daily discharge rate variations were compared between the 2 study periods.
  
  
  RESULTS
  There were a total of 2734 discharges, 1446 occurring in the pre-change period, and 1288 in the post-change period. There was overall smoothing of the daily discharge rates, and a reduction of 0.3 days in median length of stay in the post-change period (P = 0.0065).
  
  
  CONCLUSIONS
  Restructuring the admission system to achieve constant daily admissions to each care team resulted in a smoothing of daily discharge rates and improved operational efficiency with shorter lengths of stay.
authors.affiliation: General Internal Medicine, Center for Innovation in Complex Care, University Health Network, University of Toronto, Toronto, Ontario, Canada. nicolas.szecket@utoronto.ca.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Szecket
authors.forename: Hannah J
authors.initials: HJ
authors.lastname: Wong
authors.forename: Robert C
authors.initials: RC
authors.lastname: Wu
authors.forename: Hershl D
authors.initials: HD
authors.lastname: Berman
authors.forename: Dante
authors.initials: D
authors.lastname: Morra
mesh_terms: D005260:Female; D006748:Hospital Departments / Q000592:standards / Q000639:trends; D006769:Hospitals, General / Q000592:standards / Q000639:trends*; D006801:Humans; D007388:Internal Medicine / Q000592:standards / Q000639:trends*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D010343:Patient Admission / Q000592:standards / Q000639:trends*; D010351:Patient Discharge / Q000592:standards / Q000639:trends*; D012189:Retrospective Studies