Enhancing Operational Efficiency by Reducing Patient Length of Stay and Increasing Patient Satisfaction: An Applied Study at King Saud Medical City

Background: Coordinated discharge processes and clinical pathways support hospital efficiency, and their implementation requires evaluation using operational and clinical outcomes. This study assessed length of stay (LOS) and discharge outcomes following deployment of a multicomponent operational improvement programme at King Saud Medical City, Riyadh. Methods: This retrospective, uncontrolled before-and-after study used routinely collected discharge records. The programme combined discharge coordination, multidisciplinary review, perioperative recovery pathways, cardiology service redesign, and ambulatory preparation. The primary analysis compared January-March 2022 with January-March 2023, when the programme was fully deployed. LOS and discharge outcomes were compared, and multivariable logistic regression assessed hospitalization exceeding seven days, adjusting for age group, sex, admission type, hospital, and ward. Results: The primary comparison included 20,981 discharges. Mean LOS decreased from 8.74 to 8.43 days (mean difference −0.31 days; 95% confidence interval [CI] −0.69 to 0.06; p=0.102), while median LOS remained four days. Hospitalization exceeding seven days occurred in 31.7% and 31.1% of discharges, respectively. Adjusted odds were lower in 2023 (adjusted odds ratio 0.926; 95% CI 0.869-0.987; p=0.019). Improved discharge outcomes increased from 88.8% to 90.5%, and mortality decreased from 5.0% to 4.1%. Conclusions: Programme deployment was associated with modestly lower adjusted odds of prolonged hospitalization, without a statistically significant reduction in mean LOS. Changes in discharge outcomes were unadjusted and cannot establish programme effectiveness. Patient satisfaction and readmissions were not measured.