Background: Extended stay (> 30 day stay) cases strain hospital resources, psychologically burden staff, increase average length of stay (ALOS) and ultimately are not patient-centric. In 2008, extended stay patients represented 15% of the average daily census on the Medicine service.
Methods: In 2008, we convened a proactive interdisciplinary team to engage in addressing barriers to care progression and discharge. The goal was to reduce the number of extended stay patients on the medicine service and overall ALOS. The team was comprised of a hospitalist physician and leadership from Care Management, Social Work, Ethics, Finance and post-acute care. Complex Care rounds occurred twice weekly. All patients with LOS of 5 days or more were presented in a standardized format, “”The Four Questions””, to ensure a shared mental model. These questions are 1.) Why is the patient hospitalized? 2.) Why is the patient STILL hospitalized? 3.) What has to happen for this patient to be discharged? and 4.) When and where is this patient being discharged to safely? A special emphasis was placed on barriers to discharge (ranging from medical, social, financial, psychological), advanced care planning and contingency planning. The hospitalist physician served as a liaison to the medical staff regarding clarification of endpoints to admission.
Results: Since the initiation of Complex Care Rounds, the percent of extended stay patients on the average daily census dropped from 15% to 1.5% (Figure 1). Our ALOS dropped from 6.81 days (2008) to 5.69 days (2016). It is important to note this decrease in ALOS occurred despite two important factors: 1.) our case mix index has increased dramatically from 1.47 to 1.81 during that same period and 2.) the initiation and vast expansion of our observation program siphoned off the short stay cases.
To cite this abstract:Hochman, KA; Presa, R; Sedgwick, T; Gross, R; Williams, D; Meara, A; Bosworth, B . COMPLEX CARE ROUNDS – A COORDINATED INTERDISCIPLINARY STRATEGY FOR CARING FOR OUR SICKEST PATIENTS. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 166. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/complex-care-rounds-a-coordinated-interdisciplinary-strategy-for-caring-for-our-sickest-patients/. Accessed January 26, 2020.