Length of Stay—A Major Priority for Hospitals

With all the talk in the news of health care reform, everyone has become very conscious about the growing cost of medical care. Hospitals face major cost control challenges as they strive to meet established and required quality, efficiency, and cost benchmarks:
•    Risk‐adjusted mortality index
•    Risk‐adjusted complications index
•    Patient safety index
•    Core measures score
•    Average length of stay
•    Expense per adjusted discharge
•    Operating profit margin
•    Cash‐to‐total‐debt ratio

I’d like to focus on two by focusing on one – Length of Stay.  It is a major priority for hospitals – assuring  quality care and efficient resource utilization.

This has become a hot topic within the NICU.  If an infant is born at 27 weeks gestation, that infant could be in the NICU for at least 75 days.  Obviously no medical professional would send a preemie home before they were ready but it has become a focus of care within NICUs to implement practices and standards of care that work toward reducing length of stay. If you’ve spent any time reading the information provided on our website, you know that reducing length of stay is one of the primary goals in implementing PAL® as a therapeutic standard of care to teach babies to suck effectively and feed productively… which, by the way is the number one reason for prolonged length of stay for a premature infant – inability to feed.  It is also a major factor for readmission.

What are the risks of increased length of stay?

1.    The longer a baby is hospitalized, the greater the risk of developing hospital-acquired infections, medication errors and serious safety events.
2.    The cost:  The average cost for a “healthy” preemie or what we in the NICU refer to as a “feeder/grower” is $1500-2000 per day.  For families that are covered under private insurance, that has a significant financial impact on the families but we also cannot forget that one third of all NICU patients are covered under Medicaid which carries a significant financial societal burden as well.
3.    It impairs the parent-child bond, because parents who are overwhelmed and stressed have trouble seeing past the “NICU-ness” of everything and in many ways “fear” caring for their child.

I do not mean this to sound “preachy” because a lot of positives come about when a problem gets recognized and addressed. For example, back in 2005 a pilot program was developed called the COPE (Creating Opportunities for Parent Empowerment) program. It was a multi-stage process that engaged parents from the onset of admission and addressed issues such as developmentally sensitive interactions with their preterm infants, specialized care of premature infants and follow up after discharge (that is a very Reader’s Digest summary) but the bottom line was that infants 26-34 weeks went home an average of four days earlier than infants who had not participated in the program and preemies <32 weeks went home an average of eight days earlier. The parents expressed less stress, less depression and anxiety during and after their infant’s NICU stay and a greater feeling of confidence in caring for their infant. This program has been implemented in NICUs across the country with the same level of success.

Also, something near and dear to my heart and one of the main reasons I joined Powers is the tremendous impact that the PAL® has on transitioning non-nutritive to nutritive (feeding) sucking in such a developmentally supportive way. NICUs across the country are developing standardized feeding protocols in an attempt to reduce length of stay and readmission… it’s that important. Anyone can feed a baby, but if we don’t teach them to eat they will not gain weight, they will get sick and we will be right back where we started. This is something I believe in – providing the absolute best care with all the resources available to us, while at the same time helping our hospital home meet their overall financial goals.

I will leave you with this factoid: In a representative state, based on established birth and survival rates, where an estimated 25% of total premature births (6,884) are covered by Medicaid at an estimated $2,000/day in the NICU, PAL® therapy and the resulting reduced length of stay* would generate an annual savings of >$60 million.  It’s important to us all.

Enjoy your August (let’s hope it gets a little cooler) and I look forward to hearing from you…

Christine Clark
Director, Hospital Services

(*5 days/infant based on published clinical study data)