Reduction in length of stay of patients

in emergency.
 Project ID :ASPIRE/SIP/ 84000
LEADER: Dr. Aditi Paul P. No. 161954

MEMBERS:
Dr. Binita Panigrahi P. No. 151602
Dr. Abinash Kumar P. No. 158651
Dr. N. Praveen P. No. 199603
Dr. Rizwan Ahmad P. No. 157163

03/21/2024 PRESENTATION TITLE 2

 Background:
Patients come to Emergency for varied reasons; some of them are
serious and others not so serious.
The non-serious patients receive treatment for relief of symptoms.
Length of stay in emergency, therefore, is a performance indicator.
There is no defined cut off duration for length of stay. However, the
acceptable length is 6 hrs.

03/21/2024 PRESENTATION TITLE 3

 Problem Statement:

 Length of stay of patients are not monitored in emergency

resulting in overstay of patients in emergency.
 Overstay results in over crowding.

03/21/2024 PRESENTATION TITLE 4

 Root Cause Analysis:
 Lack of awareness of importance of length of stay.
 Absence of instrument for monitoring length of stay.
 Delay in specialist consultation.
 Delay in reports.
 Absence of patient relative.

03/21/2024 PRESENTATION TITLE 5

 Cause-effect analysis
DOCTOR PATIENT
Lack Of Mind set of patients
Awareness

INCREASED
LOS
Long
Turnaround No Direct Admissions To
Time Of Reports Wards CAUSE SUBCAUSE EFFECT

Lack Of
MAN Awareness Increased LOS
MACHINE METHOD
MACHIN No VBG/TROP Long Turnaround Time
E I Of Reports

No Direct
03/21/2024 METHOD Admission Delay In Consultation
6
 Cause-effect analysis
DOCTO PATIENT
R
Lack Of Mind set of patients
Awareness

INCREASED
LOS
Long
Turnaround No Direct Admissions To
Time
03/21/2024
Of Reports Wards CAUSE SUBCAUSE
7
EFFECT

Lack Of
MAN Awareness Increased LOS
MACHINE METHOD
MACHIN No VBG/TROP Long Turnaround
E I Time Of Reports

No Direct Delay In
METHOD Admission Consultation
 Goals:

Awareness of doctors.
Decrease in length of stay as far as possible.
Quick rotation either in form of admission or discharge from
emergency.
Make beds available for critical beds as well as supportive hands to
manage real emergencies.

03/21/2024 PRESENTATION TITLE 8

 Action Points:
Doctors were identified for data collection.
Register was modified as per need.
Data were discussed in departmental MRM.
Analysis done as per data.
Interdepartmental cross referrals were being monitored.
Delay in getting reports

03/21/2024 PRESENTATION TITLE 9

 KEY ACTIONABLES:
Doctors were identified based on their experience.
Register was modified with addition of various column –time of
entry in observation; time of discharge/admission; cause of delay
in cases of greater than 6 hours stay.
Patients with more than 6 hours stay were discussed in
departmental meetings for analysis of delay.
Interdepartmental meetings were undertaken where decisions were
taken for early consultation for absolute necessary patients.

03/21/2024 PRESENTATION TITLE 10

 Register for LOS

03/21/2024 PRESENTATION TITLE 11

 Total patients audited
700
655
612
600
485
500 431 442
396
400
302 303
300

200

100

0
May-22 Jun-22 Jul-22 AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER

03/21/2024 12
 LOS >6 HRS
45

40
39
35 37 37

30 31
25
25 25
20
19
15
14
10

0
May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22

03/21/2024 13
 LOS >6 HRS
39
37
35 38

31

26
25 25
25
21

19

14

10

Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23

03/21/2024 PRESENTATION TITLE 14

 LOS >4 HRS
157
142

124

101
92 97

Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23

Series1 Series2

03/21/2024 PRESENTATION TITLE 15

 Average LOS
MONTH ALOS
MAY 22 4.15
JUNE 22 3.54
JULY 22 3.21
AUGUST 22 3.41
SEPTEMBER 22 4.05
OCTOBEER 22 3.4
NOVEMBER 22 4.1
DECEMBER22 4.3

JANUARY23 3.8
FEBRUARY 23 3.9

03/21/2024 PRESENTATION TITLE 16

 MONTH ALOS

JUNE 22 3.54

JULY 22 3.21

AUGUST 22 3.41

SEPTEMBER 22 4.05

OCTOBEER 22 3.4

NOVEMBER 22 4.1

DECEMBER22 4.3

JANUARY23 3.8

FEBRUARY 23 3.9

MARCH 23 4.52

APRIL 23 4.01

MAY 23 3.25

JUNE 23 3.35

03/21/2024 17
 5
4.52
4.5 4.3
4.05 4.1 4.01
4 3.8 3.9
3.54 3.41 3.4
3.5 3.21 3.25 3.35
3
2.5
2
1.5
1
0.5
0
22

22

23

23

23

23
2

22

22

22

3
l-2

-2

-2

-2
r-
n-

g-

v-

c-

n-

b-

n-
p-

ct

ar

ay
Ju

Ap
De
Ju

Ju
Au

Fe
Se

Ja
No
O

03/21/2024 PRESENTATION TITLE 18

 MONTH ALOS
JULY 23 4.29
AUGUST 23 4.06
SEPTEMBER 23 4.12
OCTOBER 23 3.02
NOVEMBER 23 4.04
DECEMBER 23 4.48

03/21/2024 PRESENTATION TITLE 19

 5 4.48
4.5 4.29 4.06 4.12 4.04
4
3.5 3.02
3
2.5
2
1.5
1
0.5
0
Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23

03/21/2024 PRESENTATION TITLE 20

 Outcome of LOS>6 hours:
100

90
93
80
80
70

60

50 54
40

30

20

10

0
ADMISSION DISCHARGE DAMA

03/21/2024 21
 Result:
Quick decision making
Ready availability of beds to incorporate new inflow of
patients
Customer satisfaction.

03/21/2024 PRESENTATION TITLE 22

 Holding on to gains
LOS FOR MARCH'23-JUNE'23

30

26
25 24 24

20

15

10
10

0
1

MARCH APRIL MAY JUNE

03/21/2024 PRESENTATION TITLE 23

 Way forward:

The point of care

TROP-I machine has been installed in emergency.
ABG machine has been installed in emergency.
Further awareness is being created among doctors to decrease LOS
by taking frequent rounds.

03/21/2024 PRESENTATION TITLE 24

 Thank you

03/21/2024 PRESENTATION TITLE 25