Improving length of stay: what can hospitals do?

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This report by the Nuffield Trust is part of a larger project undertakenby Monitor aiming to find the best ways to improve quality of careacross the whole health system in light of recent pressures on theurgent and emergency care system. While reducing emergencyadmissions is difficult to achieve and hard to sustain, a more effectiveway to manage the growing demand for beds may be to focus onreducing length of hospital stay – the subject of this report.There is a significant opportunity to reduce length of hospital staythrough improvements in internal processes and the developmentof alternative services. There are often variations in length of stay,even for patients with similar conditions, and wide variations inthe proportion of patients with extended stays. This suggests thatimprovements could be made. Drawing evidence from the literaturetogether with insights from a number of case studies and a numberof senior clinicians and managers, this report explores whatapproaches to reducing length of stay have been (and could be)effective by providing a set of measures for improving length of staythat are within the control of the hospital itself.This report complements further work by Monitor publishedconcurrently looking at how to help local health system leadersdecide whether to invest in schemes that deliver care closer topatients’ homes.