The giant gift zucchini that I received on my desk signals that August is here! While I can’t quite manage to keep most of my houseplants alive, I am *told* that August is a peak time for picking, and aside from that, an opportunity to relax and enjoy some of the fruits of one’s labor. August is perfectly in between, since summer isn’t quite over but autumn hasn’t quite shown up yet. Summer veggie gardens are peaking with tomatoes, cucumbers and other seasonal crops while late-season flowers are in full bloom.
We aren’t at a point to relax our length of stay efforts just yet though! Key topics for this month include length of stay to date and “why not home, why not today.”
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Length of stay: Numbers won’t finalize until mid-month, but LOS at PSPH and PCH appear close to budget at 6.48 and 4.82 days respectively, improving slightly from the prior month but still not decreased significantly overall this year. We continue to stand out with now the highest LOS in our division, followed by Providence Alaska Medical Center coming in at a 6.2-day LOS for July. August (with limited early data) is trending high, meaning there is opportunity there for the rest of the month!
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Why not home as the next site of care? Remember to consider a discharge home as the default. There are many patients for whom home is not an option… but we should consider it first for most of our patients rather than as an afterthought. This allows time for the necessary planning and coordination among our care teams to ensure a safe home discharge.
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Discharge to home remains the least restrictive next site of care.
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Three quarters (75%) of our patients discharge to home.
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Discharges home have the lowest observed to expected (O:E) ratio, meaning patients that go home have a length of stay closer to what we would expect.
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Discharges home allow patients to recover in a familiar environment.
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Discharging patients home with or without home health has been associated with lower length of stay, higher patient satisfaction scores and more improvements with activities of daily living (ADL), while readmission rates are generally similar, given that more complex patients will go to a post-acute care facility.
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Discharges to Skilled Nursing Facilities (SNF) have an O:E of more than 2, meaning patients stay twice as long as we expect them to!
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South Puget Sound sends twice as many patients to SNFs than other hospitals in our system.
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Our LOS efforts around discharges to SNF include partnerships with local SNFs to ease the transition to SNF including around complex case discharges and developing software to allow our Care Management teams to initiate insurance authorizations for more visibility of that process.
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While we continue to work on improving SNF O:E, much of that process remains out of our control, with the top two causes for delay being lack of guardianship and limited SNF access due to no accepting facility.
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Patients who fail to discharge to SNF have significant delays, particularly when there is no backup plan in place
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