VA finds shorter stays don't lead to readmissions
■ Mortality rates also decreased with shorter stays, but the study did find that readmissions rose when facilities cut the length of stay by too much.
Hospitals have been under pressure to reduce costs and send patients home earlier, and there has been speculation that shorter stays would mean more readmissions. But a 14-year study of Veterans Affairs hospitals found that reducing a patient's stay does not increase the chance that person will be readmitted later.
Researchers studied more than 4 million admissions from 1997 to 2010 in 129 VA hospitals. Hospital lengths of stay dropped 27%, and readmission rates after 30 and 90 days went down by 16%. Mortality rates at 30 and 90 days decreased by 3%. The study was published in the Dec. 18, 2012, issue of Annals of Internal Medicine (link).
Reducing the length of a hospital stay can have positive effects for the patient as well as a hospital's bottom line, said Peter Kaboli, MD, lead author of the study, who conducted the research with colleagues from the Iowa City VA Medical Center.
“Every day someone sits in a hospital bed is one more day they can get an infection,” he said. “They can get the wrong medication. They fall. … The message should be that patients should stay in the hospital as long as it takes to get the care they need and not a moment longer.”
The study did find a tipping point when hospitals cut length of stay too short. When a hospital's mean length of stay was one day shorter than the average for that hospital, readmission rates went up 6%, Dr. Kaboli said.
Researchers took a look at five of the most common diagnoses for patients being admitted: acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, pneumonia and gastrointestinal hemorrhage. Across the five diagnoses, the mean length of stay dropped from 5.44 days to 3.98 days. Overall, the 30-day readmission rate dropped from 16.5% to 13.8%.
More VA hospitalists
Dr. Kaboli attributes the reductions to the push in the mid-1990s at VA hospitals to increase quality and efficiency, and the addition of hospitalists.
“We went from about 10% of VAs having hospitalists to about 80% over the study period,” he said.
Results from VA hospitals aren't generalizable, because the VA is a single hospital system where patients are more likely to be older and male and have more chronic illness and higher rates of substance abuse, researchers say.
Still, the VA “functions as the largest [accountable care organization] in the country,” Dr. Kaboli said. “We get fixed payments for patients to take care of them. So in many ways, even though we are different, we are a model for the rest of the country on how they should be doing some things.”