Variations in patients’ length of stay imply there should be significant opportunities to reduce length of hospital stay; whether through improvements to internal processes or development of alternative community-based services.
This Nuffield Trust report explores which approaches to reducing length of stay (LOS) are most effective. It is a component of a larger project by Monitor aiming to reduce the demand for hospital beds and improve quality of care across the health system, particularly given pressures on urgent and emergency care. A further aim is to supply evidence for deciding whether to invest in schemes which deliver care closer to home.
“Reducing emergency admissions is difficult to achieve and hard to sustain. This report focuses instead on reducing length of hospital stay…”
Principles of good practice include:
- Focus on patient flow.
- Focus on the basics:
- Setting expected dates of discharge.
- Planning discharge from the point of admission.
- Identifying complex discharges.
- Developing standardised evidence-based pathways for recognised patient types.
- Structured ward rounds.
- End-of-life care planning.
- Improving communication for better handovers and transitions.
- Bundled approaches.
- Information systems which assist rapid decision-making, proactive patient management and continuous monitoring of patient progress.
- Active support for discharge seven days a week.
- Devolving greater responsibility to staff for quality improvement; allowing freedom to test changes as part of their daily work.
Lewis, R. [and] Edwards, N. (2015). Improving length of stay: what can hospitals do? London: Nuffield Trust, September 9th 2015.
Related Developments: Monitor’s Improving Patient Flow Workstream
Here is an overview of research activity from Monitor in preparation for coming Winter pressures:
- Urgent and emergency care performance.
- Schemes to deliver care closer to home.
- Improving productivity in elective care.
- Further options for improving patient flow.
Improving patient flow: evidence to help local decision-makers. London: Monitor, September 3rd 2015.
Possibly also of interest, a 2014 analysis of trends in admissions and bed use over previous years, with population projections to explore pressures on hospitals for the future:
Smith, P. McKeon, A. Blunt, I. [and] Edwards, N. (2014). NHS hospitals under pressure: trends in acute activity up to 2022. London: Nuffield Trust, October 2014.
More on the Cause(s) of Blockages in Patient Flow Through Hospitals
The following Nuffield Trust briefing proposes that the main problem is due to limited capacity to move patients into hospital wards.
Karakusevic, S. (2016). Understanding patient flow in hospitals. London: Nuffield Trust, October 2016.