For the first quarter of 2024, the national average length of hospital patient stays improved across both month-over-month and year-over-year performance. Despite these gains, hospital throughput remains a significant problem for health systems, continuing to adversely impact bed availability, at a time when demand for care exceeds supply, hospital resources are stretched thin and hospital margins are under duress.
Given both the quality of care and financial operating implications of poor patient flow, improving hospital throughput has become a focus for health system C-suite executives, with significant financial upside possible for most health systems. The topic is frequently discussed in trade publications, draws large crowds at industry gatherings and has given rise to a genre of process management consulting firms focused on reducing the average length of hospital stay.
And, yet, even with all this focus, the challenge persists.
It’s not just that throughput is a particularly vexing problem. It’s that generally the industry is not thinking about it in quite the right way. When teams convene to improve hospital throughput, they tend to approach the problem through a lens of operational effectiveness within the four walls of the hospital. The theory being that by improving hospital operations—including speed, productivity and resource allocations—hospitals can shorten the distance between admission and discharge.
That internal operations focus is not wrong. But it is not enough. No matter how efficient hospital discharge planning becomes, the rate-limiting factor on improving length of stay performance is having an appropriate, coordinated and timely available discharge destination.
It is critically important to recognize the need to build out an ecosystem of community-based care options, providing varying levels of care and including both the home and post-acute skilled nursing facilities.
Creating this care ecosystem outside the four walls of the hospital is a strategy that requires data and analysis to inform selection of the right ecosystem partners, the creation of an aligned network of resources and facilities, as well as processes to enable timely, coordinated and appropriate transitions as patients leave the hospital. The challenge is that post-acute care can have highly variable performance and has traditionally operated independently which can make alignment difficult.
The strategic work we are doing is accelerating and optimizing hospital throughput with a sustained focus on improving quality of care and patient satisfaction. We are developing unique expertise organizing people, processes, and resources within the acute care setting starting at the point of admission. We are also creating an ecosystem of post-acute resources to optimize the care patients receive after discharge.
This approach uses data to create a network of high-performing post-acute options and measure and manage performance across that ecosystem with agreed-upon targets. As such, we have created alignment with our post-acute providers, who now accept transfers on privileged terms that align with our hospitals’ targets for appropriate length of stay. Additionally, we have protocols in place that provide guidance on readmissions after initial discharge.
This strategy has allowed us to achieve high performance in our hospitals for throughput and capacity management. In less than a year, we have saved 24,808 inpatient days, reduced discharge to skilled nursing facilities length of stay by 1.61 days and decreased discharge to home health length of stay by 0.89 days.
In a market where demand for beds exceeds supply, and many hospitals are operating on thin margins, better management of hospital throughput is an imperative. To succeed, executives at health systems should think differently, shifting our thinking from an internal hospital operating focus (though that remains important), to a comprehensive strategy that anchors on giving patients the right care setting, at the right time to best meet their care needs. The payoff on our approach has freed up scarce bed capacity in our acute inpatient settings and improved patient health outcomes and satisfaction while also having a significant positive impact on our bottom line.
Dominica Tallarico is the executive vice president and chief operating officer of Allina Health. She provides strategic oversight for effective integration and efficient operations for Acute Care, Ambulatory Services, Post-Acute Services, Clinical Service Lines, Ancillary Clinical Services, Information Technology and System Facilities at the Minneapolis-based health system