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Reducing Extended Hospital Lengths of Stay

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Case Reports in Clinical Medicine 2024年第5期13卷 171-177页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse NY USA

In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.

关键词： Hospitals Hospital Efficiency Hospital Lengths of Stay

Supporting Efficiency in Health Care at the Community Level

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Case Reports in Clinical Medicine 2021年第8期10卷 213-219页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse NY USA

Health care providers and payers in the United States have worked to provide care at reasonable costs. This has frequently been a challenge. For example, the COVID epidemic has generated large expenditures with limited efforts to contain costs. Based on the experiences of providers in Syracuse, New York, this study suggested that realistic approaches are necessary to improve health care efficiency. It described three programs that have improved utilization at the community level. They have included the diversion of large numbers of ambulances that directed patients to emergency departments where care was most available. They have also involved length of stay reduction that saved thousands of patient days and made additional inpatient care available in hospitals. They have also included the use of ambulatory surgery to reduce the need for inpatient care. The data from these programs demonstrated that efforts to improve the efficiency of care can reduce inpatient utilization and improve outcomes. The Syracuse hospitals have used them to make additional capacity available for COVID patients and other populations.

关键词： Hospitals Ambulance Diversion Hospital Lengths of Stay Ambulatory Surgery

Changes in Hospital Utilization at the Community Level

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Case Reports in Clinical Medicine 2023年第8期12卷 285-291页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse USA

This study evaluated developments in adult medicine and adult surgery inpatient discharges of the Syracuse, New York metropolitan area during a five-year period. The study demonstrated that adult medicine discharges declined by 19.1 percent and adult surgery discharges declined by 25.1 percent between January-April 2019 and 2023. The study also indicated that discharges for both services increased slightly, 2.8 - 6.2 percent, between January-April 2022 and 2023. The study data suggested that some of the reduction in adult medicine discharges resulted from less use of health care services related to the coronavirus epidemic. It also demonstrated that reduced use of adult surgery services was associated with greater utilization of ambulatory surgery and other outpatient services in the community. The results of the study suggested that hospitals in the United States may experience less utilization of inpatient services in the future.

关键词： Hospitals Hospital Discharges Hospital Utilization

Estimating the Future of Health Care at the Community Level

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Case Reports in Clinical Medicine 2024年第7期13卷 241-248页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse NY USA

Developments in health care in the United States are changing the delivery of services for providers and payors. This study focused on inpatient hospital discharges in the Syracuse hospitals and other services. It demonstrated that, during the past five years, numbers of inpatient adult medicine discharges had increased while adult surgery discharges had declined. This information suggested that adult medicine discharges could be expected to increase and approach levels of five years ago. It also suggested adult surgery discharges could be expected to remain at previous levels or decline. This information indicated that the combined emergency department visits declined from 238,000 to 202,000 between 2019 and 2020, then increased from 218,000 to 228,000 visits between 2021 and 2023. These developments will probably result in greater efficiency at the community level. With a decline in numbers of inpatient beds, providers will be able to focus on the more efficient management by reducing numbers of staff as well as fewer pharmaceuticals and testing.

关键词： Hospitals Long Term Care Health Care Costs

Developing Additional Hospital Capacity at the Community Level

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Case Reports in Clinical Medicine 2022年第1期11卷 1-7页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse USA

Hospitals in the United States are being challenged to provide the capacity for adult medicine and surgery care. The study suggested that the hospitals of Syracuse, New York have generated additional inpatient capacity through a number of efforts. One program involved moving some low severity of illness inpatient procedures to ambulatory care. A different approach has also avoided inpatient utilization by diverting incoming ambulances to different providers. The third program evaluated in the study, length of stay reduction, was a different type of initiative. It has generated additional inpatient capacity by reducing the amount of inpatient care provided. In effect, it has increased inpatient capacity by addressing the efficiency of care. These programs illustrate the potential for improving hospital capacity at the community level. Each of them was developed by acute care providers using local services.

关键词： Hospitals Hospital Emergency Departments Hospital Lengths of Stay

Hospital Utilization and Health Care Planning

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Case Reports in Clinical Medicine 2022年第12期11卷 520-526页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse NY USA

This study evaluated changes in inpatient adult medicine and adult surgery services in the metropolitan area of Syracuse New York. These are the two largest inpatient hospital services. The study involved the use of these services as a basis for health care planning over time. The first component of the study focused on changes in hospital discharges for adult medicine and adult surgery. It demonstrated that, between the first three quarters of 2019 and 2022, before and after the coronavirus epidemic, numbers of adult medicine and adult surgery discharges declined by 16 - 21 percent. The second component of the study focused on changes in hospital lengths of stay for adult medicine and adult surgery. It demonstrated that, between the first three quarters of 2019 and 2022, hospital inpatient lengths of stay increased by approximately 19 - 21 percent at the aggregate and hospital specific levels. Effective planning involving utilization indicators such as hospital discharges and efficiency will be necessary if the potential for effective management of this sector is to be preserved. This planning should involve comparisons of data such as hospital discharges and stays, and identification of the sources of these developments at the community level.

关键词： Hospitals Hospital Discharges Health Planning

Estimating the Potential for Reduction of Hospital Capacity at the Community Level

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Advances in Bioscience and Biotechnology 2016年第4期7卷 225-231页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse NY USA

This study estimated the potential impact of the nationwide shift from inpatient to outpatient care in the hospitals of Syracuse, New York, a small metropolitan area with a relatively stable population. The study employed the 3MTM All Patients Refined Diagnosis Group Severity of Illness system to identify inpatients and related utilization with the greatest potential for movement from inpatient to outpatient settings. The study data suggested that the development of additional ambulatory care capacity in Syracuse could support the reduction of an average daily census of approximately 60 - 125 patients with low severity of illness, excluding readmissions. The study data also identified the potential for shifting an average daily census of approximately 9 - 19 patients who were readmitted to hospitals within 30 days of their initial admissions from inpatient to outpatient care. The study data also identified the potential for reduction of an average daily census of approximately 20 - 70 adult medicine and adult surgery patients through continued initiatives for inpatient length of stay reduction. The impact of initiatives in each of these areas could result in a reduction of the combined average daily adult medicine and adult surgery census of the Syracuse hospitals from approximately 90 to 215 patients. This would amount to between 8 and 20 percent of the current inpatient census for adult medicine and adult surgery. These data suggest that planning for initiatives such as ambulatory care development and reduction of readmissions should also include evaluation of their impact on inpatient acute care and related services.

关键词： Hospital Utilization Hospital Admissions Hospital Readmissions Hospital Lengths of Stay

Monitoring Hospital Use in the Epidemic

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Case Reports in Clinical Medicine 2020年第7期9卷 177-183页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse NY USA

This study reviewed developments in hospitalization in the metropolitan area of Syracuse, New York during the initial months of the Coronavirus epidemic. The study was based on the use of inpatient discharge data and information contained in daily utilization reports for the three hospitals in the community distributed by the Hospital Executive Council. The data demonstrated that the medical-surgical and critical care inpatient census, as well as the emergency department volume peaked in January 2020 and declined gradually during February and the first half of March as a result of the seasonal influenza season prior to the epidemic. The data showed that with the onset of the epidemic in mid-March, the data identified substantial reductions in the use of inpatient beds and the emergency departments. The medical-surgical and critical care censuses declined by 31.2 and 29.3 percent respectively. This resulted from provider and public efforts to free inpatient beds for coronavirus patients. During April and May 2020, the use of medical-surgical beds and emergency departments in the Syracuse hospital gradually increased as the Coronavirus epidemic plateaued. Subsequent data will identify whether the use of inpatient medical - surgical beds and emergency department visits in the Syracuse hospitals return to the levels before the epidemic.

关键词： Hospitalization Epidemic Influenza

Changes in Inpatient Hospital Utilization at the Community Level

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Case Reports in Clinical Medicine 2024年第9期13卷 358-365页

作者： Ronald Lagoe shelly littau Hospital Executive Council Syracuse NY USA

This study demonstrated that numbers of hospital inpatient discharges have declined in the metropolitan area of Syracuse, New York. The largest impact has been in adult medicine and adult surgery, the hospital services with the highest utilization rates. Reductions in inpatient care have also affected services with lower utilization, such as pediatrics, obstetrics, and mental health. The study indicated that, between January - June 2019 and 2024, adult medicine discharges declined by 11.9 percent and adult surgery discharges declined by 24.6 percent. A large proportion of the reductions involved orthopedic surgery. They indicated that more than 50 percent of the joint replacements in the Syracuse hospitals have been moved to outpatient services. These patients included those with low severity of illness. The study suggested that reductions in hospital discharges could contribute to the efficiency of care. Fewer inpatient admissions could reduce the need for staffing and other resources. Information from the Syracuse hospitals has suggested that these reductions may continue.

关键词： Hospitals Hospital Inpatients Adult Medicine Adult Surgery