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Go Lean:
Staying Power
Quality and efficiency go hand-in-hand

Tony Denton - Ruste WilkeCOO Tony Denton and lean coach Ruste Wilke, R.N., M.S.N., review length of stay data.The Health System aims to provide patient-centered care that is safe, effective, timely, efficient and fair. One of the key measures of inpatient efficiency is length of stay (LOS), the time that patients reside in the hospital. Our goal is for each patients stay to be appropriate - not too short and not too long - which requires coordinated planning of care and transitions to other settings.

UMHS measures average LOS on a monthly basis to monitor performance against plan and to check for opportunities for improvement. In May 2008, LOS measured at 6.3 days; in May 2009, LOS was at 6.19 for inpatient discharges across all hospitals.

"For the average length of stay across all hospitals, this represents important progress, particularly with our ongoing high occupancy in many inpatient units," says Hospitals and Health Centers Chief Operating Officer Tony Denton. "There are many process improvement initiatives underway across the organization, with many teams in place to continue our push in the right direction."

Cardiac Surgery used lean thinking to get to the root cause of its LOS issues. Clinical Nurse Specialist Jole Mowry, R.N., says, CVC OR and intensive care unit worked hard to wean patients from their ventilators in a more timely manner, and to transfer and discharge STC (surgery thoracic cardiac) patients as soon as possible. The result: A 10 percent decrease in LOS. Mowry adds, "With the new extubation process and an uncomplicated cardiac surgery critical care path, we hope to improve on this patient outcome even more."

Similarly, using lean thinking concepts, Vascular Surgery reduced its average discharge time of day by almost two hours, now getting patients out the door by 1:30 p.m. "And we expect discharge time to continue to improve with our new process," says lean coach Ruste Wilke, R.N., M.S.N.

Denton attributes the hard work of physicians, nurses and other staff - and lean thinking across the Health System - to the improvements in LOS figures he sees month by month.

"By decreasing unnecessary length of stay, we are doing the right thing for our patients, which we hope will also reduce expense per case and improve our financial bottom line," he says. "Delays in care and discharge are expensive and may impact patient quality. In addition, delays mean a patient is using a bed that another patient cannot occupy... we want to optimize our patient flow so we can provide care to as many patients as possible." -CM

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