DRG’s, diagnosis-related groups, are a method of grouping hospitalized patients into classifications with similar care processes and predictable service ranges (HMSA, 2018). DRG’s are categories for defining hospital admission cases. In 2014 according to HCUP, the Healthcare Cost and Utilization Project, the top ten DRGs by hospital admissions were lower extremity arthroplasty, sepsis, heart failure, gastrointestinal disease, cerebrovascular disease, spinal procedures, pneumonia, mental disorders, bowel, rectal, adhesion surgery and cardiac arrhythmias (Khurana & Vashishta, 2019). The average length of stay is the average duration of stay in a hospital stay by a patient, in days. ALOS is a used as an efficiency indicator, with shorter durations reducing cost per discharge (OECD, 2017). The ALOS for the top ten DRG’s by hospital admissions were: 3.2 days for lower extremity arthroplasty, 3.35 days for sepsis, 5.3 days for heart failure, 5.5 days for gastrointestinal disease, 6.4 days for cerebrovascular disease, 14 days for spinal procedures, 5.4 days for pneumonia, 8.6 days for mental disorders, 4.3 days for bowel, rectal, adhesion surgery and 3.5 days for cardiac arrhythmias (HCUP, 2016).

There is a lot of managerial and political pressure to maintain LOS within optimum levels in order to lower costs without compromising on the health outcomes of patients. However, efforts to reduce LOS are limited by the need for quality and efficiency. Age, marital status, sex, location of residence, severity of illnesses, patient’s physical and mental status, hospital infections and complication are some of the factors that affect ALOS (Amrita & Badgal, 2015). It is therefore necessary to implement the necessary interventions to reduce ALOS. Some ways to do so include ensuring discharge planning is conducted on the admission day so as to discharge patients as fast as clinically possible. Communicating with patients and staff helps to ensure that patients advance as fast as possible through their milestones and discharge. Educating the care teams on care coordination advances the above procedures. Identifying and addressing any likely barriers to early discharge while the patient is admitted reduces their time of stay. Adequately staffing the case management department is another way to reduce the ALOS. Overworked managers may not be able to process all the patients’ discharges in time which may lead to extra costs (Allen, 2019). Another strategy to reduce the ALOS is to strategically schedule the operating room. This allows patients a longer recuperation duration thus reducing their LOS. Implementing multidisciplinary rounds involving patients and their families allows everyone in the care team to be on the same page regarding medication, discharge efforts and discharge barriers. Such rounds effectively enhance hospital patient throughput. Additionally, knowing which tests can be conducted as outpatient also reduces the patient LOS. This can be achieved through transition clinics. Finally, eliminating boarding in the emergency department can also reduce the ALOS. The quicker a patient transitions from the ED to a nursing unit, the faster the assessment and treatment of the issue can occur and the quicker the discharge. All these methods ensure that patients receive the right care at the right place, time, in a cost-effective and safe way.

References

Allen, J. (2019). Reducing The Hospital Length Of Stay. The Hospital Medical Director. Retrieved 23 July 2021, from https://hospitalmedicaldirector.com/reducing-the-hospital-length-of-stay/.

Amrita, A., & Badgal, A. (2015). FACTORS AFFECTING THE AVERAGE LENGTH OF STAY OF THE PATIENTS IN THE INPATIENT DEPARTMENT IN A TERTIARY CARE CENTRE IN NORTH INDIA. Journal Of Evolution Of Medical And Dental Sciences, 4(02), 150-155. https://doi.org/10.14260/jemds/2015/25

HCUP. (2016). Exhibit 4.3 Average Length of Stay and Average Charges. Hcup-us.ahrq.gov. Retrieved 23 July 2021, from https://www.hcup-us.ahrq.gov/reports/factsandfigures/figures/2006/2006_4_3.jsp.

HMSA. (2018). Diagnosis Related Group (DRG). Hmsa.com. Retrieved 23 July 2021, from https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm.

Khurana, A., & Vashishta, S. (2019). Diagnosis Related Group-Based Readmission Profiling | The Milliman Healthcare Analytics Blog. Info.medinsight.milliman.com. Retrieved 23 July 2021, from http://info.medinsight.milliman.com/2019/08/diagnosis-related-group-based-readmission-profiling/#ednref6.

OECD. (2017). Average length of stay in hospitals. Health At A Glance, 176-177. https://doi.org/10.1787/health_glance-2017-64-en