Loma Linda University Medical Center Loma Linda, CA, United States
Steve Serrao, MD, MPH, PhD1, Nichole Desmond, RD, MHPA2 1Loma Linda University Medical Center, Loma Linda, CA; 2Providence Health Care, Spokane, WA
Introduction: Providence Sacred Heart Medical Center & Children's Hospital is a 644-bed not-for-profit acute care hospital in Spokane, Washington. A quality improvement process was implemented for patients with upper GI bleeds (UGIB) with a goal to improve clinical, operational and financial outcomes.
Methods: A retrospective review of hospital wide data for UGIB cases, from July 2018 to 2019 was followed by a 3-month operational intervention. The FIVE step intervention included 1) Enhanced communication and workflow, 2) Guideline directed, time sensitive resuscitation and endoscopy, 3) Reduction in the inappropriate utilization of PPI infusions, 4) Proactive endoscopy directed throughput management from inpatient, discharge and post-discharge planning and 5) Optimizing labor utilization.
Variables of interest included consult to endoscopy times, case mix index (CMI) adjusted length of stay (LOS), direct cost per case including labor, supplies, and PPI infusions.
Results: A total of 271 patients with UGIB during the baseline period, generated a total direct cost of $2.67 million and an average LOS of 5.14 days. The average direct cost per case was $9,850; the CMI adjusted cost was $7,700. Upon implementation of the intervention, a downward trend was realized in the MedSurg and Critical care LOS from an average of 4 days to around 2.2 days (Fig.1). A realized savings was noted during the three-month study period (Fig.2). A closer analysis (Fig.3) showed that the greatest impact to direct hospital savings, was realized by the reduction of staff overtime. While professional fees increased by $1,000 over the three-month period, the standard practice applied by the GI hospitalist resulted decreased utilization of PPI infusion (see Fig.4) and a reduction in pharmacy expense of $10,000 and direct supply expense by $5,000. During the study period we observed a $76,000 reduction in direct costs with average monthly savings approximately $25,000. Over the performance period of July 2019 to 2020 a total of 342 patients were treated for UGIB, resulting in a total direct cost of $2.94 million with an average LOS of 4.37 days. After the intervention the non-adjusted cost per case dropped by $1,267 and CMI cost/case $1,174. The annual savings over baseline was noted to be $528,194.
Discussion: Efficient and consistent workflows improved throughput when combined with a guideline driven protocol. This resulted in better clinical outcomes for patients, and improvement in length of stay, utilization and direct costs.
Figure: Abstract graphs figure 1 to 4.
Disclosures: Steve Serrao indicated no relevant financial relationships. Nichole Desmond indicated no relevant financial relationships.
Steve Serrao, MD, MPH, PhD1, Nichole Desmond, RD, MHPA2. P0413 - A GI Hospitalist-Guided Quality Improvement Intervention on Hospital Workflow, Resulting in Improved Operational and Financial Outcomes in the Management of Upper GI Hemorrhage, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.