Length of Stay and Geometric Mean Length of Stay (GMLOS) –
Why and how do we use GMLOS
The GMLOS is a statistical measure to calculate the average length of a patient’s hospital stay, taking into account the entire distribution of stay lengths and minimizing the impact of outliers, O:E is a comparison of our observed (O) to expected (E). Our GMLOS O:E (despite our length of stay progress) hovers around 1.5 (at St. Peter, 1.2 at Centralia). Translated, this means that a patient with a diagnosis that would on average stay 3 days, when admitted to St. Peter stays 4.5 days: similarly, a patient with an expected stay of 7 days on average stays 10.5 days. There are differences between patient populations where our GMLOS O:E for patients going to SNF is around 2 (those patients stay with us twice as long as expected) and our patients going home have a GMLOS O:E of 1.2. We are working on initiatives to make the entire care teams aware of the expected GMLOS so that we can plan according to that. We should aim to get our patients ready for discharge by their GMLOS if not before their GMLOS, to accommodate those complex patients who we know will be more likely to be above the GMLOS.
Hospital Acquired Infection (HAI) Prevention
(Why? Injuries and infections associated with hospitalization and associated with additional cost for patients and healthcare systems) CAUTIs and CLABSIs – we failed to meet our CAUTI and CLABSI goals at St. Peter for 2024. See Dr. Kondal’s article this month on our initiatives to decrease CAUTIs.
Perioperative Documentation
(Why? CMS compliance, TJC RC.02.01.03) I need your help with ensuring we are meeting documentation requirements. Guidelines require that an operative or other high-risk procedure report is written or dictated upon completion of the operative or other high-risk procedure and before the patient is transferred to the next level of care. Communication and use of the electronic health record helps to inform caregivers of information important to next site of care. Ensure the History and Physical is in the chart and accessible to the care team, dated (within last 30 days) and with an interval update, and that operative note(s) and medication reconciliation are completed before patients transition to the next site of care. Our ORs and procedural areas are required to hold our physician and APC teams accountable for meeting these standards.
Suicidal Ideation and Suicide Screening
(Why? NPSG 15.01.01 EP2) Suicide risk screening is intended to help identify individuals at risk who may require further assessment and steps to prevent them from attempting suicide. The Joint Commission requires healthcare organizations to use a validated tool for their suicide risk screening, and to ensure screening is used appropriately and accurately in order to yield the intended results. We are required to use an evidence-based assessment process or tool in conjunction with clinical evaluation. Our validated tool of choice is the C-SSRS or Columbia Suicide Severity Rating Scale (https://phs-wapsph.policystat.com/policy/15225262/latest#autoid-5k5ba). Look for assigned training on how to use this tool according to our policy above soon!