Reducing Excess Days Initiative

Excess days were identified as an area for improvement due to the disparity between hospitals within the RHC system and the Centers for Medicare & Medicaid Services geometric mean assigned to the MS-DRG. Increased days in the hospital have safety, infection, satisfaction and financial ramifications for both the patient and hospital. Plan-Do-Study-Act was used and the following initiatives were implemented: redesign and deployment of case management best practices; clinical best practice order sets; revised case management staffing levels; system-wide readmission reduction; monthly meetings for case management leadership; and attendance at site utilization management committee meetings and the performance excellence highway (educational program for physicians). To monitor progress, concurrent review of excess days, monthly and weekly control chart analysis and annual 'heat map' of excess days were implemented. Improvement was noted in excess days.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)