Peggy Duggan, MD, executive vice president and chief medical officer of Tampa (Fla.) General Hospital, discourages employees from asking "How can I get patients out of the hospital sooner?"
Instead, she encourages every staff member to ask, "What does my patient need today?" The answer, she finds, often leads to more efficient care and length-of-stay improvements.
Like many health systems nationwide, Tampa General is struggling with high patient volumes and capacity challenges. But rather than focus efforts — and team conversations — on directly trimming length of stay, Ms. Duggan has instead built a culture focused on safe, efficient care.
The hospital formed a committee to oversee this work, with the core goal to improve care, knowing length-of-stay improvements would follow.
"What I really drove in that committee was, 'What do our patients need today? Are they getting everything they need?'" Dr. Duggan told Becker's. "So finding where there's waste and how we can really close that gap, rather than thinking about 'I want to decrease length of stay.'"
This strategy proved highly effective at gaining buy-in from physicians — more so than any length-of-stay mandate would, according to Dr. Duggan.
"Physicians are not going to respond to a mandate. It's not important to them, but they do want their patients to get what they need in real time," she said. "So we just flipped that question to be about what does your patient need today. And if we're consistently giving it to them, great, and if there's a way we need to improve so that we are even better, we'll make that change."
The committee has taken a data-driven approach to identifying improvement areas, and every project or subcontract has focused on the resources patients need to get their care delivered more efficiently. In one instance, the hospital found it could send tests to a different lab and get them back two days faster, eliminating delays for some of its transplant cases. Tampa General has also trimmed length of stay by increasing the amount of staff members working overnight who can image patients.
When rolling out this change, a staff member asked Dr. Duggan: "What do we do if the patient is upset that we're imaging them at midnight?"
For Dr. Duggan, the messaging is clear: "We're willing to have staff here around the clock for you so that you get the care you need in the most efficient way."
As the region's largest safety net hospital, Tampa General cares for some patients who do not have a place to go after an inpatient visit, often resulting in longer stays. In response, the hospital redesigned case management, embedding case managers within its clinical teams and giving them more time to develop relationships with specialty units and facilities that can take patients with specific needs.
As part of its sepsis work, the hospital transitioned many safety net patients to receive Telavancin as a weekly outpatient infusion, rather than keeping them inpatient to receive daily antibiotics.
"We had some patients stay six weeks for antibiotic therapy," Dr. Duggan said. "We've been able to shift those patients back to the outpatient setting. It's a little more expensive drug than we would use on the inpatient side, but we are saving bed days and we've saved about half a million dollars doing that."
Overall, the hospital has trimmed length of stay by eight-tenths of a day in just one year. Equally as important, the work has been rewarding and fulfilling for clinicians, according to Dr. Duggan.
"We've made a significant impact in our length of stay, and everyone feels like it was a really wonderful initiative because we were improving care delivery," she said.