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Recommended Citation
Smith A, Geil K, Johnson K. Impact of Multidisciplinary Rounds on Adult Inpatient Length of Stay A Quality Improvement Initiative. Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background and/or Rationale: Multiple factors influence patient’s length of a stay (LOS). Studies examining patient demographics, hospital characteristics, and diagnoses indicate that older age, certain diagnoses, and admission to critical care units are associated with longer LOS.
Local Problem: At a non-profit hospital in the Midwest, nurses identified challenges in achieving reductions in the budgeted LOS for adults admitted to inpatient units.
Method: To reduce budgeted LOS, multidisciplinary rounds (MDRs) were optimized through a methodical approach involving direct observation, process mapping, and root cause analysis. A Length of Stay Committee was established, standardizing MDR practices and integrating these into workflows. The Quality Improvement (QI) team conducted Plan-Do-Study-Act (PDSA) cycles focusing on afternoon scheduling of MDRs, proactive identification of patients for next-day discharge, and implementation of a real-time communication tool, enhancing team coordination. These interventions aimed to streamline discharge processes, effectively reducing LOS. Key metrics were selected for each PDSA cycle, validating forward progression, driving the next cycle of change.
Results/Conclusion: Results indicate a significant improvement in the LOS for adult in-patients from January 2023 to April 2024. Initially, the adult LOS varied, peaking at around 4.6 days in June 2023 and decreasing to approximately 3.5 days by April 2024. This downward trend closely approached the target LOS, particularly from December 2023, consistently nearing or meeting targets. These improvements correlate with the implementation of enhanced MDRs, and other strategic operational changes aimed at increasing efficiency.
Implications: The project utilized budgeted LOS metrics, facilitated by strong collaboration between care management, nursing, finance, and physicians optimizing outcomes. The interdisciplinary partnership enhanced communication and response effectiveness. The use of multiple PDSA cycles allowed for adaptive, real-time responses, while a centralized discharge tracker tool enabled effective discharge planning. Preliminary results and ongoing enhancements, such as incorporating a virtual RN for admissions and discharge support, suggest this model's potential for broader application.
Document Type
Poster
Publication Date
11-13-2024
Impact of Multidisciplinary Rounds on Adult Inpatient Length of Stay A Quality Improvement Initiative
Background and/or Rationale: Multiple factors influence patient’s length of a stay (LOS). Studies examining patient demographics, hospital characteristics, and diagnoses indicate that older age, certain diagnoses, and admission to critical care units are associated with longer LOS.
Local Problem: At a non-profit hospital in the Midwest, nurses identified challenges in achieving reductions in the budgeted LOS for adults admitted to inpatient units.
Method: To reduce budgeted LOS, multidisciplinary rounds (MDRs) were optimized through a methodical approach involving direct observation, process mapping, and root cause analysis. A Length of Stay Committee was established, standardizing MDR practices and integrating these into workflows. The Quality Improvement (QI) team conducted Plan-Do-Study-Act (PDSA) cycles focusing on afternoon scheduling of MDRs, proactive identification of patients for next-day discharge, and implementation of a real-time communication tool, enhancing team coordination. These interventions aimed to streamline discharge processes, effectively reducing LOS. Key metrics were selected for each PDSA cycle, validating forward progression, driving the next cycle of change.
Results/Conclusion: Results indicate a significant improvement in the LOS for adult in-patients from January 2023 to April 2024. Initially, the adult LOS varied, peaking at around 4.6 days in June 2023 and decreasing to approximately 3.5 days by April 2024. This downward trend closely approached the target LOS, particularly from December 2023, consistently nearing or meeting targets. These improvements correlate with the implementation of enhanced MDRs, and other strategic operational changes aimed at increasing efficiency.
Implications: The project utilized budgeted LOS metrics, facilitated by strong collaboration between care management, nursing, finance, and physicians optimizing outcomes. The interdisciplinary partnership enhanced communication and response effectiveness. The use of multiple PDSA cycles allowed for adaptive, real-time responses, while a centralized discharge tracker tool enabled effective discharge planning. Preliminary results and ongoing enhancements, such as incorporating a virtual RN for admissions and discharge support, suggest this model's potential for broader application.