Study Of Reducing ALOS Of Orthopedics In A General Hospital

BackgroundALOS is the length of stay of the discharged patients in a certain period of time, which is an integrated indicator to measure whether hospital management mechanism and the operating mechanism is smooth or not,and the level of the effectiveness, efficiency,medical quality and technical capacity of a hospital.It is not only the indicator of how long the patients take the medical services in a hospital,but also the reflection of the comprehensive ability of medical service of a hospital.It is important to the hospital managers to pay attention to the management of ALOS.With the medical reform,ALOS has an increasing important impact on medical quality, hospital fees,medical insurance reinhousement,and patients' satisfaction.So gradually it gains the concern from the hospital managers,the health care workers,the medical insurance management,the patients and their families.Due to the distinction between the different kinds of diseases,the ALOS of different kinds of diseases are different.It is important for us to manage ALOS.Reducing ALOS has a good influence on the hospital and the patients to some extent,which can reduce the hospital fees,expand the capacity of the hospital,and increase the social effectiveness and economic effectiveness of the hospital.ObjectivesIt aims to study the influencing factors of ALOS of orthopedics in a Shanghai general hospital,to analyze the proportion of the unnecessary length of stay and to explore the reasons,and to find the way to reduce ALOS.ContentsFirst,analyze the inpatient cases at the orthopedics of the hospital from 2003 to 2007, and study the influencing factors of ALOS using correlation analysis method and the multiple regression method.Second,according to AEP,review the appropriatenese of LOS of osteonecrosis of the femoral head(ANFH) patients' in 2007,and to estinate the sums and the proportions of the unnecessary length of stay and the respective fees. Finally,make recommendations to reduce ALOS.MethodsThe study collected the records of orthopedic patients from the computer center and the medical record room,who discharged from 2003 to 2007.The study did descriptive analysis of these patients' length of stay and the fees,the correlation between the bed-using index and ALOS.Analyze the ratio of beds to health care workers.The study conducted the analysis method and multiple regression method to identify the influencing factors of ALOS of the most ten frequent diseases of orthopedics in 2007 by STATA.The study selected ANFH cases,of all cases totaled 351,to evaluate their appropriateness.The researchers reviewed the daily treatment process and analyze the reasons of unnecessary length of stay by questionnaires.They checked the finished questionnaires,and analyzed the unnecessary length of stay in six reasons.ResultsThrough the analysis of the influencing factors of LOS of the most ten frequent diseases of orthopedics,the study/paper finds that waiting days before surgery,kind of surgery,blood filtering,age,season of admission,and number of other diagnosis had influences on LOS of over six kinds of diseases.Among them,waiting days before surgery,blood filtering and kind of surgery had influences on LOS of 10 kinds,9 kinds and 8 kinds of diseases,respectively.Marital status,race and admission diagnosis is whether the same to discharge diagnosis or not had no impact on these diseases.Blood filtering and kind of surgery can not be controlled by the hospital, which is decided by the situation of patients.It is the most important to pay attention to waiting days before surgery,which is management factors.Through the study of the unnecessary LOS of ANFH patients in 2007,the study/paper finds that the proportion of the unnecessary LOS of the total LOS was 15.63%,and proportion of the patients having the unnecessary LOS of the total patients was 67.81%.ALOS can be reduced 2 days by subtracting the unnecessary length of stay from the total length of stay.The average cost of the unnecessary LOS was one-twentieth of that of necessary LOS.So decreasing the unnecessary LOS can reduce the burden of patients effectively,boost the bed utilization rate,improve the economic effectiveness of the hospital,and solve the problem of the admission of patients.Among 6 reasons,waiting surgery,waiting inspection reports and delay in discharged from the hospital are the most important the causes of unnecessary LOS. Thought the further research,there was half of the unnecessary LOS happened on weekends.The unnecessary LOS which happened from the 3rd day to the 7th day occupied 80%total LOS,and the costs of the 5 days occupied 70%of total costs.Through the study of influencing factors of LOS of ANFH patients by the correlation analysis method,the paper/study finds that the correlation coefficient between the unnecessary LOS and LOS is 0.2911.Kind of surgery,waiting days before surgery and the unnecessary LOS are the main influencing factors of LOS. Among the important influencing factors,waiting days before surgery and the unnecessary length of stay,belonging to the management factors,can be controlled by the hospital,while demographic factors and clinical factors are decided by the situations of patients.There is 80%of the unnecessary length of stay belong to the waiting days before surgery.So decreasing the unnecessary length of stay can improve the bed utilization rate and solve the problem of the admission of patients.According to the study of reducing ALOS of orthopedics,there are five recommendations made.Collaboration between different departments should be paid attention to,and detections and surgeries in the weekend should be developed. Admission examination should be transferred from inpatient to out-patient.Clinical work after surgery should be passed to community health service centers.Reduce the unnecessary length of stay by improving the efficiency of the key hospital stay.Adjust the proportion of the health care works to solve the personnel problem.