Fifty ways to reduce length of stay: an inventory of how hospital staff would reduce the length of stay in their hospital.
OBJECTIVE
In this study we present a bottom up approach to developing interventions to shorten lengths of stay. Between 1999 and 2009 we applied the approach in 21 Dutch clinical wards in 12 hospitals. We present the complete inventory of all interventions.


METHODS
We organised, on the hospital ward level, structured meetings with the staff in order to first identify barriers to reduce the length of stay and then later to link them to interventions. The key components of the approach were a benchmark with the fifteenth percentile and the use of a matrix, that on one side was arranged along the main phases of the care process--the admission, stay and discharge--and on the other side to the degree to which the length of stay could be shortened by the medical specialists and nurses themselves or by involving others.


CONCLUSIONS
The matrix consists of a wide variety of interventions that mainly cover what we found in published research. As a bottom up approach is more likely to succeed, we would advise wards that have to reduce length of stay to make the inventory themselves, using appropriate benchmark data, and by using the matrix.
Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, The Netherlands; Dutch Health Care Inspectorate, Utrecht, The Netherlands. hj.borghans1@igz.nl
Ine
I
Borghans
Rudolf B
RB
Kool
Ronald J
RJ
Lagoe
Gert P
GP
Westert
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017598:Efficiency, Organizational; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009426:Netherlands; D011787:Quality of Health Care / Q000458:organization & administration*; D055815:Young Adult