Initiatives to Reduce Length of Stay in Hospital: A Rapid Evidence Synthesis
Measures to reduce the length of hospital stay are among the main approaches to enhance a hospital's operational efficiency. For the NHS, the size of the productivity opportunity in acute hospitals alone has been estimated to be more than £4.5 billion, including savings from reducing length of stay.
It is against this background that RAND Europe has conducted a rapid review of the evidence of the effectiveness and efficiency of initiatives for reducing length of stay in hospital. Funded by the NIHR Health Services & Delivery Research Programme, the project examined the impact of initiatives on the quality of care and on patient experience and also explored factors that facilitate or hinder the implementation of initiatives in England by means of key informant interviews.
Although the overall evidence base was varied and frequently lacked a robust study design, we identified a range of interventions that showed potential to reduce length of stay. These were multidisciplinary team working, for example some forms of organised stroke care; improved discharge planning; early supported discharge programmes; and care pathways.
Nursing-led inpatient units were associated with improved outcomes but, if anything, increased length of stay. Factors influencing the impact of interventions on length of stay included contextual factors and the population targeted. The evidence was mixed with regard to the extent to which interventions seeking to reduce length of stay were associated with cost savings.
Recommendations for Research
Reviewing the evidence presented in this report, we have identified a number of gaps in the evidence that would benefit from further research to usefully inform practice. We offer a small set of recommendations for further research, relating to the design, implementation and evaluation of organisational interventions seeking to reduce length of hospital stay:
- Greater attention should be given to the theoretical underpinning of the design, implementation and evaluation of interventions or programmes.
- There is a need for further research using appropriate methodology to assess the effectiveness of different types of interventions in different settings.
- Different evaluation approaches may be useful, and closer relationships between researchers and NHS organisations would enable more formative evaluation.
- Full economic costing should be undertaken where possible.
Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment, Health Services and Delivery Research, 2:52, December 2014.