Abstract
Extended average length of stay (ALOS) leads to increased hospital expenditure. Prioritization of emergency endoscopies over routine elective procedures results in delay and adds on to patients’ ALOS at tertiary hospitals. The gastroenterology department of Fiona Stanley Hospital aimed a service improvement project to shorten the ALOS of inpatients by implementing a new quarantined booking and procedural system allowing elective access to endoscopic procedures. An additional endoscopy list (quarantine list) was implemented with full participation of the stakeholders once a month for a 3-month trial period for inpatients by moving resources from a nearby satellite service. A comparison of the ALOS of patients before and after realizing the preceding intervention was carried out using the time and date information obtained from the theater management and the e-referral system of all routine inpatients with a valid e-referral for gastroscopy or colonoscopy. Upper gastrointestinal endoscopies comprised over two-thirds of the inpatient scopes performed. The ALOS and average time spent for referral improved by 1.09 and 1.97 days, respectively. The ALOS reduced by over 1 day, and improvement was noticed in the prereferral segment. Postreferral efficiency did not improve, and undertaking further analysis to determine the root causes for the continual delay is recommended.
Highlights
Revenue and expenditure are the two most important financial issues that influence the viability of any health care organization
Expenditure closely reflects the average length of stay (ALOS), which when increased above benchmarking criteria will drive inappropriate increased hospital expenditure
Preintervention Phase The ALOS was determined for all inpatients who were referred for nonurgent endoscopic procedures for a period of 1 month prior to implementation of the intervention
Summary
Revenue and expenditure are the two most important financial issues that influence the viability of any health care organization. Emergency endoscopies are prioritized above more routine elective inpatient referrals, often resulting in the postponement and delay of routine procedures. Such postponements or delays are a common cause for dissatisfaction among clinicians, patients, and caregivers [3]. Preintervention Phase The ALOS was determined for all inpatients who were referred for nonurgent endoscopic procedures for a period of 1 month prior to implementation of the intervention. This was sourced from data extracted from the theater management system (TMS) and electronic inpatient referral (e-referral) system. The ALOS and the average elapsed time from admission to referral and referral to discharge were calculated during this period of time
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