Tuesday, May 15, 2012
Remember when most minor surgeries resulted in a two- or three-day stay in the hospital? Today, with the cost of hospital beds, many of these operations are now done on an outpatient basis.
Those surgeries that do result in a hospital stay are usually short – shorter than they should be, according to a pair of logistical studies conducted by researchers at the University of Maryland's Robert H. Smith School of Business.
The studies show a correlation between readmission rates and how full the hospital was at the time of discharge, suggesting that patients went home before they were healthy enough. They further suggest that revenue drives the decision about when a patient is discharged.
The researchers recommend better planning and other logistical solutions to avoid these problems.
"Discharge decisions are made with bed-capacity constraints in mind," said University of Maryland Professor Bruce Golden, who conducted the research with Ph.D. student David Anderson and other colleagues. "Patient traffic jams present hospitals and medical teams with major, practical concerns, but they can find better answers than sending the patient home at the earliest possible moment."
In the studies, Golden and Anderson tracked patient movement at a large, academic medical center located in the United States. They found that patients discharged when the hospital was busiest were 50 percent more likely to return for treatment within three days.
This indicates recovery was incomplete when patients were first released, the researchers say. The study tracks occupancy rates, day of the week, staffing levels and surgical volume.
Golden says surgeons and hospitals are incentive-driven to perform as many surgical procedures as feasible. The more surgeries, the more revenue.
"The hospital has to maintain revenue levels to meet its financial obligations,” Golden said. “Surgeons are working to save lives and earn a livelihood. It's what they do, If the hospital says 'sorry there are no beds available,' there's a lot of tension and pressure from both sides to keep things moving."
Golden says big hospitals tend to have these problems more than smaller ones. Larger hospitals tend to provide more advanced, specialized surgeries not accessible at smaller, community institutions,the researchers say. Patients often have to travel a great distance for the procedures, so hospital delays become expensive for both them and the care providers.
Ask more questions
Part of the problem can be resolved with better planning, the researchers say.
They suggest that surgeons use checklists before discharging the patient, asking more question about the patient's readiness to go home.
Also, the studies suggest that hospitals increase the flexibility of where patients go post-surgery. Allowing them to be moved to units with empty beds, for example, could also lessen premature discharges.
Though this may increase costs in the short run, discharging patients who then quickly return to the hospital offers no long-term savings, and decreases the quality of care, Golden said.
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