Improving length of stay on a trauma service

Abstract

BackgroundReducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized patient management would lead to decreased LOS.MethodsRetrospective analysis of Trauma Registry data compared LOS before (PRE) and after (POST) implementation of standardized processes on a trauma service. Patients were subdivided by age (over and under 65 years). Data were compared using unpaired t-test, χ2 test and analysis of variance tests, where appropriate.Results1613 PRE and 1590 POST patients were compared. Although age and Injury Severity Score were similar, median LOS decreased by 1 day for the group overall (p<0.0001), and for subgroups over and under the age of 65 years (p<0.0001). Older patients were discharged home 13% more often in POST, compared with 4% more for younger patients.ConclusionsImproved standardization of processes on a trauma service reduced LOS in patients of all ages. A prospective study may identify specific factors associated with prolonged LOS, to allow further improvement.Level of evidenceIII.Study typeTherapeutic/Care management.

Trauma Patient-Centered Discharge Plan Form: A Pilot Study

“…To provide optimal care to injured patients, trauma centers should identify ways to enhance the discharge process to improve throughout, facilitate posthospitalization care, and prevent readmission. A comprehensive, multidisciplinary discharge planning process can improve patient outcomes and decrease length of stay (Bardes et al, 2017;Biffl et al, 2021;Collins et al, 2014) and reduce the incidence of readmission and complications (Coffey et al, 2019). In a prospective study of patients discharged from a general medical service at a tertiary hospital, Forster et al (2003) found that 20% of patients had adverse events after discharge, many of which were preventable.…”