SHM Converge Scientific Abstract ePoster Gallery-Impact of Geographic Cohorting on Length of Stay and Readmissions

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This quality improvement study evaluated a bundled intervention on one academic general medicine unit from April to September 2021. The intervention combined geographic cohorting of providers and patients, standardized twice-daily multidisciplinary rounds, and added case management support focused on discharge planning and readmissions reduction. Outcomes were compared with both a historical control from the same unit and concurrent control units, using propensity score weighting to balance patient characteristics.<br /><br />The main finding was a meaningful reduction in hospital length of stay (LOS) on the intervention unit. LOS was about 16–17% shorter than in both comparison groups, with estimated time ratios of 0.83 versus historical controls and 0.84 versus concurrent controls. Importantly, this shorter LOS did not appear to increase 30-day readmissions. Readmission rates were essentially unchanged compared with the historical control (15.6% vs 15.7%) and lower than the concurrent control (15.6% vs 20.3%).<br /><br />The study found little evidence that the intervention changed discharge timing during the day or substantially improved estimated discharge date accuracy. Patients with ICU stays were more likely to be in the intervention group, likely reflecting improved throughput and patient flow. The intervention unit also experienced increased ICU transfers, suggesting more efficient movement of patients through the hospital.<br /><br />Overall, the study suggests that a bundled approach to geographic cohorting, structured multidisciplinary rounds, and enhanced case management can improve LOS without worsening readmissions. Based on these results, the health system expanded these practices to other teams and units.

Asset Subtitle

Aubrey D. Jolly Graham

Meta Tag

Author List Alyssa Platt, Aubrey D. Jolly Graham, David Gallagher, Emily Fletcher, Kristian Knutsen, Nilesh Patel, Vonda Capps

Category Research

Concept Geographic Cohorting

Concept Hospital Length of Stay

Concept Multidisciplinary Rounding Model

Concept Case Management

Concept 30-Day Readmission

Distinguished Non-Finalist

Presenter Organization Duke University Hospital

Presenting Author Aubrey D. Jolly Graham

Track Value in Hospital Medicine

Keywords

quality improvement

bundled intervention

length of stay

readmission rates

geographic cohorting

multidisciplinary rounds

case management

discharge planning

hospital throughput

propensity score weighting

Geographic Cohorting

Hospital Length of Stay

Multidisciplinary Rounding Model

Case Management

30-Day Readmission