DNP Final Report: IMPROVING LENGTH OF STAY OUTCOMES USING STRUCTURED BARRIER ROUNDS: A QUALITY IMPROVEMENT PROJECT

Prolonged length of stay (LOS) in the acute care setting is a challenging issue driven by multiple factors. Increased LOS is associated with mortality, hospital-acquired infections, patient safety events, functional impairment, decreased quality of life, social isolation, and increased cost of care. The causes of increased LOS in the medical-surgical unit are unclear, necessitating an evidence-based project to address the problem. The purpose of this quality improvement initiative was to implement structured interdisciplinary barrier rounds and evaluate their effect on LOS, opportunity days, and estimated cost of care in a medical-surgical unit. The facility complex care coordinator (CCC) was identified as the trainer and subject-matter expert for this project due to her prior experience with evidence-based case management projects focused on rounding, throughput, and discharge planning. Charge nurses, physical therapy, and case management were identified as the multidisciplinary team. Drawing on evidence from the literature and a tool developed by the project lead, the 3 W’s of barrier rounds was used to guide the implementation of early-morning barrier rounds. The tool consisted of three questions: 1. What is the estimated date of discharge? 2. What is the barrier to discharge? and 3. Who needs to remove the barrier? Barrier rounds were completed at the nurse’s station, Monday through Friday, excluding holidays, for 12 weeks from eight forty-five to nine o’clock in the morning. All scheduled weekday barrier-round sessions were completed. Approximately 30 patients were discussed during each weekday barrier-round session. 5 During the 12-week implementation period, 1,800 medical-surgical encounters were reviewed, and 1,674 inpatient encounters were included in the final analysis after excluding observation cases. The results were analyzed for 1,674 patients admitted to the medical-surgical unit over a 12 week period. Before the intervention, the facility's average LOS (ALOS) was 3.7 days, and the medical surgical unit's was 4.2 days. Post-intervention, the ALOS of the medical-surgical unit reduced to 4.1 days, reflecting a 0.1-day reduction. Opportunity days on the medical surgical unit decreased from 1.328 to 1.310, reflecting a 0.018 reduction. The estimated cost reduction was $212 per patient encounter, resulting in a projected total savings of $354,888 across 1,674 medical-surgical encounters. The implementation of structured barrier rounds was associated with modest improvements in LOS, opportunity days, and estimated cost of care among medical-surgical patients. Informal feedback suggested that barrier rounds also supported communication and collaboration among multidisciplinary team members.