Reduction in length of stay of discharges from a Chilean Pediatric Unit.

 

Problem: 

The improvement work was done in the Pediatrics Unit at The Rancagua Hospital in the 6th Region of Chile. The Rancagua hospital is the most specialized of all the hospitals in the region. Its pediatric department provides healthcare coverage to children from the entire region. The population of which is 780,000 inhabitants; 27% of them are children. The service has 44 beds, including 12 critical care units.

In 2003 the average length of stay was 6.1 days and it was considered too long. The undesired effects of prolonged hospitalization included a high risk of nosocomial infections, emotional distress due to extended separation from families and high costs for the healthcare system. Causes of this problem included alack of strategic planning and team goals, a lack of methodology on the part of management control, low commitment and motivation of the healthcare team, and a low profile of the former leader. In summary, personnel worked together without engagement or without an explicit common purpose.

Intervention: 

The improvement work begun with strategic planning and included the participation of the whole team. A new leader, the chief of service, outlined the vision that was understood and shared by the team. Afterwards, the strategic planning allowed everyone to participate in the construction of the mission and values. Furthermore, we established targets in different areas such as reducing the rate of nosocomial infections, personnel absenteeism, the rate of misdiagnosis and re-admissions.

Length of stay reduction became the most important management goal as a benchmark of the new way of doing things within the service. Monthly management outcomes were made known to the team and indeed they committed their effort to reaching the defined goals. At the same time, we implemented a new outpatient clinic for early discharges after the hospitalization where the pediatrician might readmit patients if necessary. This pediatrician belongs to the unit medical staff and has the medical record of the patient so the clinical assessment is accurate.

A discharge survey was applied to assess patient satisfaction, which became the center of clinical activity.

Results: 

The average length of stay was reduced from 6.1 days in 2003 to 4.4 days in 2009, with a sustained reduction overtime.

The Balance Scorecard included indicators in four perspectives: financial, organizational processes, capabilities of personnel and of customers.

The effects were far from the initial goal because the pediatric team realized that all members of the care team were capable of improving the quality of healthcare and the measurement of customer satisfaction validated the change.

Pediatric personnel behavior demonstrated pride in working in a well recognized service which has been shown as an example of participative improvement.

Lessons: 

The average length of stay was reduced from 6.1 days in 2003 to 4.4 days in 2009, with a sustained reduction overtime. The Balance Scorecard included indicators in four perspectives: financial, organizational processes, capabilities of personnel and of customers. The effects were far from the initial goal because the pediatric team realized that all members of the care team were capable of improving the quality of healthcare and the measurement of customer satisfaction validated the change. Pediatric personnel behavior demonstrated pride in working in a well recognized service which has been shown as an example of participative improvement.

 

Countries: 
Report Author(s): 
Heidy Leiva, M.D. , M.P.H., M.B.A.
Organization(s): 
Hospital of Rancagua Chile
ASSIST publication: 
no
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