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Is Length of Stay A Nurse Sensitive Quality Outcomes?

03/01/2016 | 3 Comments

Is “Length of Stay” A Nurse Sensitive Quality Outcomes?

I am almost certain that some of you might be offended by the title of this blog. I believe that length of stay (LOS) is a quality metric by itself. Of note, it has been used in recent years as a proxy for quality. In addition, we know that the longer our patients stay in an acute care hospital bed, the more likely they are to develop a hospital acquired condition. Therefore, we can extrapolate that the shorter the LOS, the safer it is for our patients, hence making it a quality indicator.

Do we as nurses have an opportunity to impact the LOS? Absolutely. Is our impact enough to qualify LOS as a nurse sensitive quality outcome? Some would argue yes and others no. The purpose of this blog is not to define that LOS is a nurse sensitive metric but rather to remind ourselves that we can and we do influence this outcome. We must seriously consider any activities aimed at decreasing LOS as part of our practice rather than a task on a check list. Let me repeat this: any activities aimed at decreasing LOS should be embraced as part of our practice.

Do you believe that as a clinical nurse you can influence LOS? Do you believe you should ALWAYS aim at transitioning your patients as quickly and safely as possible to the next level of care? What is your self-interest (what’s in it for you) as a nurse to move patients quickly and safely to the next level of care?

Source: Sylvain "Syl" Trepanier, DNP, RN, CENP, past vice president & system chief nursing officer
Content Updated: 3/1/2016 2:04:32 PM
3 comments about this post
Laura Sittler 3/1/2016 3:43:37 PM

Wow. What a great blog topic. Definitely worth the topic of conversation and discourse. I believe as nurses we own advocating for patients including being mindful of their total cost of care. And appreciating how nurses have the ability to manage the phases of care for each and every patient. Thanks for the ability in this blog to generate the ability to influence this excellent aspect of total patient centered care

Carol Griffith 3/1/2016 5:48:48 PM

LOS is a nursing quality measure. Unfortunately it is my opinion that some may have lost their focus when it comes to LOS. There is a delicate balance between keeping the patient no longer than necessary and sending them home too soon. Most patients are very complex and need significant teaching prior to discharge but unfortunately there is no longer that extra time to do so. As soon as the patient is well enough to actually participate effectively they are discharged...gone are the days when you could teach a little here and then build on this. Discharge teaching is crammed into a short time frame usually after the patient has been told they are going home. This is the worst possible time to teach as it is like trying to teach a bunch of kids a new concept the last day of school. They are not retaining the information at all. And then the Hospitalists are financially rewarded for meeting a quota that may not match the patient. All of these things appear to me to be a recipe for failing the community we strive to serve... Thank you Carol for your opinion. In deed we have to ensure patients leave as soon and as safely as possible. The challenge ahead of us is to identify how to best offer the proper instruction / education at the right time and in the right setting. I wonder how we can best leverage community resources or home health even in meeting the educational needs of the people we serve? Does everything need to be done in the hospital? Probably not. Dr. Syl

Sara Strickland 3/3/2016 1:36:26 PM

Thank you for the great post Syl. I absolutely believe that LOS can be nursing driven as well as physician driven. Firstly, our nursing care impacts events that occur that can be shown to increase length of stay (CLABSI, HAPU, etc.) As nurses, when we provide quality care, we assist our patients in getting out earlier. Furthermore, our ICM and nursing team work to advocate for patients and drive care at the bedside to ensure that the physicians are well informed and that the patient's care is carried out in a timely manner. Secondly, I really like the comments Carol made about education. On the Rehab Unit, we have a big focus on education and how it can make a huge impact on a patient's stay. When patients are able to learn and care for themselves, not only are they learning, but they are empowered and encouraged emotionally, which will impact their drive. I think early education has a potential to truly impact our length of stay and other quality indicators such as readmissions as well. I think it is important to remember that length of stay isn't about pushing patients out quicker, it is about finding the right balance of treating those emergent conditions while setting the patient up with outpatient and community resources that will allow them to flourish well past hospital care. I think Premier Health is doing an excellent job of recognizing this and focusing and creating those resources that allow patients to have care through all of life's challenges, not just acute events. Thank you Sara and great commments. Dr. Syl

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