Professor University of Arizona College of Medicine Phoenix
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Introduction: Prolonged length of stay(LOS) is known to increase both morbidity and mortality among hospitalized patients. This is a widespread issue affecting both ICU and non-ICU patients and is associated with higher costs for the healthcare system and the patients. Published literature reports LOS ranging from 4 to 25 days, with costs of $4,000 to $11,000 per day. The average LOS in 2023 was 22 days at our large academic quaternary referral center in the MICU.
GOAL: To develop a multidisciplinary approach that enhances our high-reliability principles and promotes proactive discharge planning, thereby reducing length of stay and improving patient outcomes. The interdisciplinary team method aligns stakeholders on discharge readiness and streamlines the process of discharging patients directly from the ICU, proactively addressing barriers to discharge. This approach increases situational awareness and respect for expertise.
Methods: This project is a quality improvement effort that involved reviewing knowledge gaps related to discharge planning, departmental needs, and perceived barriers to discharge. Multidisciplinary huddles, including key stakeholders, were established. Stakeholders included Intensivists, APPs, CCM fellows, case managers, medical directors of care coordination, social workers, ethicists, and LTACH representatives. Huddles were initially held three times a week, and once knowledge gaps were addressed, they were reduced to twice weekly to support discharges throughout the week. Run charts and PDSA cycles were used to collect data and present findings to the team and organization.
Results: The average length of stay within the MICU decreased from 22 days to 19.5 days by the end of 2024 and further declined to 17.6 days YTD in 2025. This represents a reduction of 4.4 days since the multidisciplinary rounding huddle began.
Conclusions: Creating an interdisciplinary approach to discharge readiness fostered a more collaborative relationship between case management and the MICU team, helping to reduce knowledge gaps regarding discharges. It also offers a secondary benefit in the form of ROI, as the decrease in days to discharge continues to improve. Providers also report better alignment and understanding, and they value the team's efforts, which supports team retention and appreciation.
