MIT Sloan Health Systems Initiative
Healthcare Lab Teams Spend Time in the ED to Reduce Length of Stay
Among hospital departments, the emergency department (ED) may see the greatest number of patients. According to the CDC, the overall ED visit rate in 2018 was about 40 visits per 100 people per year in the United States. The rate was highest for infants under one year (101) followed by adults aged 75 and over (52). In 2019, approximately 22% of adults aged 18 and over had visited the ED in the past 12 months. Chances are you have a personal story about waiting for care, perhaps longer than you wanted to, at an emergency department. Length of stay inefficiencies continue if a patient is admitted, which may keep patients in beds longer than needed when that resource could be better utilized by sicker patients.
Given its heavy use and potential for efficiency improvements, emergency departments are sites of interest to Healthcare Lab students. In the Fall 2021 term, Healthcare Lab projects focused on length of stay (LOS) issues at two different EDs at Boston-area hospitals: Boston Medical Center (BMC) and Lahey Hospital and Medical Center (LHMC). Despite being very different organizations with differing populations served and catchment areas, both sites exhibited similar problems.
One of the Healthcare Lab sites, LHMC in Burlington, MA, is part of the Beth Israel Lahey system, which is composed of both academic medical centers, and teaching, specialty and community hospitals. Similar to other hospitals, Lahey’s ED is experiencing a surge in patients. The project, however, did not focus on LOS in the ED, but rather on an LOS challenge further into the process: hospital admissions from the ED. At Lahey, there is a shortage of inpatient beds. At the same time, there are many patients who are admitted as in-patients from the ED. The goal of this project was to find a way to ensure that the in-patient beds went to patients who would be staying more than 48 hours, and to increase the availability of beds overall.
The student team analyzed nearly 5000 admissions from the ED over a four-month period in 2021. Originally, they hypothesized that patients given a higher acuity rating in the ED would have longer LOS. Surprisingly, they found that LOS was similar across all acuity levels.
Healthcare Lab team member, Phani Gadde (EMBA 2022), remarked that the biggest surprise was the inpatient length of stay for Friday admissions. “Lack of personnel and services over weekends result in a longer length of stay,” he noted. The problem was not enough available services for inpatients over the weekend because there were fewer available clinicians and test appointments on Saturdays and Sundays. Therefore, patients stayed in the hospital over the weekend until Monday when staffing levels increased. Although the team started by investigating what happens in the ED, the LOS problem became evident on the inpatient wards. The team made recommendations for changes to the ED as well as to staffing to mitigate the challenges of fewer available tests, services and clinicians over the weekend that resulted in longer stays.
Another Healthcare Lab team focused on ED LOS at Boston Medical Center (BMC), the largest and busiest supplier of emergency services in New England. BMC is a health safety net hospital for Boston and unlike the state’s private hospital systems, it operates on very slim margins. BMC’s ED serves more than 130,000 patients per year; in June 2021, LOS ballooned to 259 minutes. This is well over the target of 192 minutes. The team analyzed ED operations to look for ways to reduce both wait time and the number of people who leave without being seen. Among their several recommendations was to introduce a pre-triage stage to screen people before they enter the ED. Those who could be better cared for at an alternative location could be redirected.
One of HSI’s goals is encouraging collaborative research in teams with members from different perspectives and experiences. The Fall 2021 Healthcare Lab class enrolled 55 students representing 10 MIT programs from undergraduate to PhD levels. Healthcare Lab has exploded in popularity over the past three years. One of the reasons is that the students can work with peers from many different backgrounds and hosts on intractable, timely, real-world healthcare challenges.