“Reorganizing care delivery at the regional medical center to reduce LOS and increase access for the uninsured”

The unexpected failure to expand Medicaid as part of the ACA has challenged medical facilities in Tennessee to effectively provide care to uninsured patients.  In response, the medical center with the largest uninsured population in the state has reorganized its coordination of care process to decrease LOS due to the lack of post-acute venues willing to accept the uninsured.  Six Sigma methodologies were deployed to determine critical actions to address LOS issues.  Tools used to identify key-drivers in patient’s LOS were: voice of customer; cause and effect diagram; proactive affinity; FMEA; Process Mapping; and a comprehensive improvement plan with PDCA.  The voice of the customer revealed three areas of focus: care coordination, availability of services and physician availability.  The project improvements plan was divided into three sub-committees to address three fundamental issues in driving LOS: discharge planning, availability of attending physicians and sub-specialties consultants. The implementation of a hospitalist program, fine tuning of case management and the availability of consultants were all focus areas to reduce LOS.  Community health and social resources were engaged. In addition, the medical center expanded its rehabilitation hospital from 20 to 30 beds, opened a 24 bed long term acute care hospital and is evaluating launching a SNF with a focus on caring for patients who are unable to be placed in a lower cost setting.  These changes produced a significant reduction in LOS from 6.49 to 4.81 days between June and December 2013.  Because of this improvement, the medical center has decreased diversions in key clinical areas and created capacity for patients needing acute hospital services.  Partnering with area mental health programs and LTC facilities, implementing a hospitalist program, and fine tuning of case management were all critical factors in the successful reorganization to reduce LOS and free resources for use by the uninsured.