With our May newsletter focused on mobility, I thought that a workout or running analogy would be appropriate! I love a good sprint – a short burst of explosive energy that gets the job done. The pain is brief and I can quickly go about the rest of my day. But so many of our efforts in life and in healthcare are distance runs, covering long distances with a sustained pace. While both sprints and distance have their own benefits, distance running enhances cardiovascular health and reduces the risk of long-term injury. The hard and fast burns out quickly, so let’s settle in for the long, steady run that lies ahead.
1) Discretionary Spending (Tightening our belts): You should have received updates from our system about the challenges looming on the horizon for the rest of the year (Home | InOurCircle). While South Puget Sound has met our budget, we budget a loss each year (i.e. our budget is a negative number). This is not sustainable, particularly in the face of federal funding cuts and other uncertainties. Each of us has to do our part to reduce spending where possible. We are doing our best to prioritize spending in areas of importance, which does mean cutting some areas. Please talk to me if you have questions or concerns.
2) Bright Spot! Length of Stay Update: Our length of stay at St. Peter is coming in at 5.6 days so far for April 2025. We haven’t reached a length of stay that low since 2021. Centralia’s LOS continues to be at or below target, coming in at 4.4 days. Length of stay is our marathon (one of many), requiring continued, focused effort for the rest of the year to continue to meet and exceed our targets. Thank you for your hard work!
3) Quality and Efficiency in Healthcare: Quality care is safe, effective, and patient-centered care that is also timely and efficient. Efficiency involves using our resources in the most productive way to deliver high quality care. While we have made significant strides in improving our efficiency, our work still remains. One measure of our efficiency is our Geometric Mean Length of Stay Observed to Expected Ratio (GMLOS O:E). This measure isn’t perfect (it’s a mean – taking out extreme values) but it’s a way to compare ourselves with other hospitals taking care of similar patients. Our GMLOS O:E to home continues to be above target, at 1.12 at PSPH (kudos to Centralia, which has hit less than 1 a few months now!). Eliminating 6-12 hours of delay for each of our patients going home can help us reach this goal. Our path to reach GMLOS O:E <1.0 continues. Similar to our length of stay journey, we can do it through continued effort. Some of our work so far includes:
a) Imaging efficiency: Reducing several hour delays between ordering and results
b) Lab efficiency: Reducing several hour delays in lab ordering and results
c) Deeper dives into coding: Are we getting the right credit (expected length of stay) for our patients going home? Are our patients coded as going home actually going home (vs. home with home health or an adult family home)?
d) Discharge efficiency and turn around time: Anticipating discharges by getting discharge meds ready, discharge teaching done, and patients discharged from the hospital within 2 hours of the order. Minimizing, but utilizing contingency discharges appropriately (e.g. discharge when ambulating, discharge after voiding trial). Communicating effectively with nursing and case management to anticipate and prepare for discharges, entering MRD (medically ready for discharge date) and EDD (expected discharge date) early, ideally within 36 and 24 hours of admission respectively.
