http://worldcat.org/entity/work/id/5341432

Better patient management practices could reduce length of stay in VA hospitals : report to the Congress

GAO reviewed Veterans Administration (VA) hospitals to determine whether VA: (1) was effectively managing its medical and surgical patients; and (2) could more efficiently reduce the length of stay for these patients. GAO found that, although the VA central office issued policy guidelines which recommended that more efficient patient management practices be used and recognized throughout the medical community, its hospital managers have not fully implemented them; therefore, many patients are hospitalized longer than necessary. GAO also found that excessive lengths of stay were attributable to surgery scheduling and times scheduled for conducting and providing the results of diagnostic test and consultations because the VA central office has not established performance expectations in those areas. Performance of diagnostic tests before admission, surgery schedules that keep delays to a minimum, and early discharge planning would contribute to more efficient patient management. VA has two methods to monitor whether efficient patient management practices are being used in its hospitals: (1) the utilization review process performed at the hospital level; and (2) the Systematic External Review Program (SERP) conducted at the central office. However, neither method has been used effectively to reduce the length of patient stays because review personnel sometimes had little or no medical background and the criteria and scope used were often inappropriate. VA believes that implementation of its new resource allocation system will move hospitals toward shorter lengths of stay, more cost-efficient care, greater staff productivity, and greater reliance on alternatives to hospital care.

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