SHM Converge Scientific Abstract ePoster Gallery-Length-of-Stay Index Outliers Discharged by Hospital Medicine Services

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This cross-sectional study examined length-of-stay index (LOSi) outliers among patients discharged by hospital medicine services at MUSC Charleston in FY23. LOSi is calculated as observed length of stay divided by expected length of stay and is used to compare hospital performance against national peers. Because a small number of very long-stay patients can disproportionately raise LOSi, the authors aimed to identify factors contributing to outlier cases and potential opportunities for improvement.<br /><br />Using the Vizient Clinical Data Base, the study reviewed 100 LOSi outliers among 6,202 patients discharged by MUSC Charleston hospitalists. Descriptive analysis focused on age, gender, payer status, admission source, admitting service, ICU time, time spent on other services before transfer to hospital medicine, discharge disposition, and reasons for discharge delay.<br /><br />Key findings included:<br />- Most LOSi outliers were admitted through the emergency department.<br />- Among 32 outliers admitted from outside hospitals, only 4 were discharged back to the referring hospital, suggesting a potential area for better care coordination.<br />- Of 37 patients with placement barriers, only 5 were ultimately discharged home, highlighting the need for stronger system-level support for post-acute placement.<br />- For 23 outliers initially admitted to non-hospital medicine services, transfer to hospital medicine occurred late, with a mean hospital day of 25 and a median of 18.<br /><br />Overall, the study suggests that delayed transfers, outside-hospital admissions, and discharge placement barriers are important contributors to LOSi outliers. The authors conclude that both hospitalists and health system leaders may be able to reduce LOSi by improving transfer processes and strengthening discharge and placement support.

Asset Subtitle

Marc Heincelman

Meta Tag

Author List Jerome Deas, Marc Heincelman, Meghan Thomas

Category Research

Concept Length of Stay Index

Concept Outlier

Concept Observed Length of Stay

Concept Expected Length of Stay

Concept Diagnosis-Related Group

Distinguished Non-Finalist

Presenter Organization Medical University of South Carolina

Presenting Author Marc Heincelman

Track Outcomes Research

Keywords

length of stay index

LOSi outliers

hospital medicine

cross-sectional study

hospital performance

discharge delay

transfer processes

placement barriers

emergency department admissions

care coordination

Length of Stay Index

Outlier

Observed Length of Stay

Expected Length of Stay

Diagnosis-Related Group