Managing Hospital Length of Stay: Are Our Assumptions Accurate?

Thomas, Patricia

Literature Review

Health care in this country is in crisis. Health care costs are increasing by double-digit rates annually (Bodenheimer and Fernandez, 2005; Sears, 2004; Shaw, 2003). The average age of Americans is rising as are the number of chronic diseases that affect these citizens (Barney, 2002; Catalano, 2003; Huber, 2000; Lasagna, 2002; Powell, 2000). Additionally, there are increasing numbers of retiring nurses (Barney, 2002, Buchan, 2002, Wakefield, 2001). The concerns of cost containment, a limited supply of qualified nurses, and increasing consumer demands for high quality care have created the need for innovative changes in care delivery.

Clinical Problem

Clinician assumptions regarding patient age, gender, and insurance coverage influence discharge planning in acute care hospitals. This study examined the impact of age, gender, and payment source on hospital length of stay (LOS) using two different case management delivery models. Care coordination, access to care, delivery of care, resource use, and financial reimbursement are key aspects of the roles fulfilled by case managers to organize care and reduce costs (Meek, 2003).

Implementation

A causal comparative study of two case management models on Medical, Surgical, and Cardiology units that represented general, intermediate, and intensive levels of care was implemented at a large Midwest hospital. ANOVA was conducted to examine the influence of age, gender, and payment source on hospital LOS.

Outcomes

The results of this study demonstrated the full immerision model of care management delivery had a statistically significant and positive impact on LOS across clincial specialty, units, and levels of care when compared to the traditional model of care management. There was no statistical significance in the LOS by gender or age. LOS management was no more effective in managed care payers than in traditional plans. The patients‟ insurance plan did have a statistically significant influence on LOS however, the Medicare population did not have the longest LOS.