Thread by @BMcGillenMD

At #SHMConverge23 Dr. Aziz Ansari from @LoyolaMedMD and I presented this talk.

We were expecting *maybe* 100 attendees.
Instead, we had SRO (350+) in the room, and others turned away at the door.

Why??? A reflective 🧵 (1/11)

2/ In conversation with our audience, LOS (or, if you prefer, “LOS O:E”) is going up everywhere. Exasperation was palpable.

More to the point: people are TIRED…tired of their performance being judged by this antiquated metric.

And, tired of being asked to “fix” it.

3/ This is the Iceberg Model of Systems Thinking.

LOS is an “event.” Therefore, measuring hospitalist performance based on LOS is superficial.

Any hospitalist will tell you it’s the “stuff” beneath the surface that drives LOS

4/ “Addressing LOS” requires addressing patterns, processes, structures, and mental models across your ENTIRE HEALTH SYSTEM…not simply an individual hospitalist’s function.

As hospitalists, we *need* our leaders to understand this.

5/ In our talk, we made it clear that hospitalists are adequately positioned—from in knowledge and skill set—to lead system-wide transformation that ultimately benefits LOS.

Any “control center” for your health system should have hospitalists at the table.

6/ So, let us lead. LISTEN to our ideas. Give us the resources to address the major drivers of LOS that keep patients in hospital.

Our audience identified these drivers of rising LOS: payer behavior, rehab availability, mental health shortages, lack of access.

7/ In short, gaps in social and structural determinants of health are driving your LOS up.

What is NOT driving your LOS up is a lack of “pre-10am discharging.”

Let’s shift our focus.

8/ If systems want to seriously address LOS, we suggest incorporation of a standardized approach - a tiered “daily management system” (DMS) to identifies barriers/patterns impacting LOS system-wide, AND DEALS WITH THEM.

A DMS filters info from bedside throughout the system.

9/ A DMS is heavily dependent on a multidisciplinary approach, is driven by reliable data, and incorporates physician leadership via trained Unit Medical Directors & Physician Advisors.

A key understanding of #HealthSystemsScience is necessary across system leaders!

10/ To summarize:
1) LOS is a reflection of system efficiency, not an individual’s functionality
2) Systems must understand the #SDOH gaps of their population, then build targeted resources
3) Standardized, multidisciplinary approaches are needed to address rising LOS

END/ Rising LOS is a universal issue in US healthcare, but can be addressed if we work together and stop with the embarrassingly basic reliance on antiquated metrics.

PS - an excellent (and timely!) read in the most recent “The Hospitalist” from @SocietyHospMed by @signaturedoc

todayshospitalist.com/hospitalist-le…

Also, big thanks to @ETSshow for the push to craft this thread! Sorry I couldn’t keep it to just 4!
#GivingPeopleWhatTheyWant
#WeAreNotEffed

@kevinjolearymd @michellebr00ks @RJmdphilly @subhaairan @MeghaGargMD @SampatMD @SuchitaSata @romilchadha @VipsMDMEd @marishaburden @whinnec - would appreciate thoughts!