Welcome to March! Spring is fast approaching, and we get about three more minutes of daylight each day this month. For this March, I wanted to focus on a few topics pertaining to Length of Stay, including attention to weekend and Monday discharges and a new Epic feature that will be out in April.
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Long Length of Stay - 2024 – For February, St. Peter is projected to come in about 6.8 days for financial length of stay (FLOS) with a geometric mean length of stay observed to expected (GMLOS O:E) of 1.5 and trending upward (our goal remains as close to 1 as possible, especially for the 75% of our patients who discharge to home). Centralia Hospital will come in close to budget at FLOS of 5.1 for February, trending downward but with a GMLOS O:E of 1.3 which is trending upward. O:E to home has been high in January and February at both ministries and is trending in the wrong direction. Our goals will become more challenging as we move through the year. We need your help and see opportunities around weekend and Monday discharges.
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Weekend and Monday Discharges – On Tuesdays through Fridays, we average slightly more discharges than admits, but Saturday through Monday we admit more patients than we discharge on average. Discharges to home are 22-25% lower on Sundays than on the overall average per day. Patients admitted on Saturdays and Sundays have a higher LOS (by 0.2 days) than if admitted during the week, while the case mix index (CMI – a measure of complexity) is lower for patients admitted on the weekends compared to workdays; patients discharged on Mondays have an average LOS 0.6 days higher than other weekdays. These factors mean that on average, we experience a dip in discharge efficiency every weekend which we struggle to recover from the rest of the week. This results in more boarding patients at the beginning of each week. Why are our patients unable to discharge over the weekends? Let me know what you think!
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Epic adding Medically Ready for Discharge (MRD) date – Epic will add a Medically Ready for Discharge or MRD date sometime in April (tentatively mid-April). This function will belong to provider teams to populate when a patient is medically ready for discharge vs. the Expected Discharge Date (EDD) which will belong to care managers and nursing teams. We aim for patients to discharge when they are medically ready, for the MRD and EDD to be the same. This functionality will allow better awareness and tracking of discharge delays once patients are medically ready to discharge.
