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

Authors

  • Mohammmad Abdullah Alanazi Director of Patients Affairs, Health Administration Department, Riyadh First Health Cluster, IAFH, Riyadh, Saudi Arabia Author
  • Mohammed Azman Alazman Director of community services, Medical Administration Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia Author
  • Bareaah Hamdan Alanazi Deputy of Director of patients services Administration, Medical Administration Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia Author
  • Razan Ridha Fayzu Head of ED Coordination Unit, Medical Administration Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia Author
  • Farhan Alanazi Model of care, Medical Administration Department, Riyadh First Health Cluster, KSMC, Riyadh, Saudi Arabia Author
  • Ali Adlan Ali General Practitioner, Department of Emergency Surgery, Al-Roseires Rural Hospital, Blue Nile Region, Sudan Author

DOI:

https://doi.org/10.65759/td5tbk09

Keywords:

Length of stay, Patient discharge, Hospital efficiency, Quality improvement, Patient flow

Abstract

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.

References

1. Bagust A, Place M, Posnett JW. Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. BMJ [Internet]. 1999 Jul 17;319(7203):155-8. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.319.7203.155

2. Singer AJ, Thode Jr HC, Viccellio P, Pines JM. The Association Between Length of Emergency Department Boarding and Mortality. Acad Emerg Med [Internet]. 2011 Dec;18(12):1324-9. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2011.01236.x

3. Rojas‐García A, Turner S, Pizzo E, Hudson E, Thomas J, Raine R. Impact and experiences of delayed discharge: A mixed‐studies systematic review. Heal Expect [Internet]. 2018 Feb 12;21(1):41-56. Available from: https://onlinelibrary.wiley.com/doi/10.1111/hex.12619

4. Siddique SM, Tipton K, Leas B, Greysen SR, Mull NK, Lane-Fall M, et al. Interventions to Reduce Hospital Length of Stay in High-risk Populations. JAMA Netw Open [Internet]. 2021 Sep 20;4(9):e2125846. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784338

5. Zepeda-Lugo C, Tlapa D, Baez-Lopez Y, Limon-Romero J, Ontiveros S, Perez-Sanchez A, et al. Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review. Int J Environ Res Public Health [Internet]. 2020 Aug 4;17(15):5609. Available from: https://www.mdpi.com/1660-4601/17/15/5609

6. Lees-Deutsch L, Robinson J. A Systematic Review of Criteria-Led Patient Discharge. J Nurs Care Qual [Internet]. 2019 Apr;34(2):121-6. Available from: https://journals.lww.com/00001786-201904000-00006

7. Fox MT, Persaud M, Maimets I, Brooks D, O’Brien K, Tregunno D. Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: a systematic review and meta-analysis. BMC Geriatr [Internet]. 2013 Dec 6;13(1):70. Available from: http://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-13-70

8. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery. JAMA Surg [Internet]. 2017 Mar 1;152(3):292. Available from: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2016.4952

9. Hedderson M, Lee D, Hunt E, Lee K, Xu F, Mustille A, et al. Enhanced Recovery After Surgery to Change Process Measures and Reduce Opioid Use After Cesarean Delivery. Obstet Gynecol [Internet]. 2019 Sep;134(3):511-9. Available from: https://journals.lww.com/10.1097/AOG.0000000000003406

10. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open [Internet]. 2013 Jan 3;3(1):e001570. Available from: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2012-001570

11. Becker C, Zumbrunn S, Beck K, Vincent A, Loretz N, Müller J, et al. Interventions to Improve Communication at Hospital Discharge and Rates of Readmission. JAMA Netw Open [Internet]. 2021 Aug 27;4(8):e2119346. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783547

12. Hameed TK, Jamil SF, Aldibasi OS, AlKhalaf HA. Impact of restructuring an inpatient pediatric service on length of stay and patient flow. Saudi Med J [Internet]. 2023 Nov 4;44(11):1127-31. Available from: https://smj.org.sa/lookup/doi/10.15537/smj.2023.44.11.20230511

13. Gonçalves-Bradley DC, Lannin NA, Clemson L, Cameron ID, Shepperd S. Discharge planning from hospital. Cochrane Database Syst Rev [Internet]. 2022 Feb 24;2022(2). Available from: http://doi.wiley.com/10.1002/14651858.CD000313.pub6

14. Abuzied Y, Maymani H, AlMatouq B, AlDosary O. Reducing the Length of Stay by Enhancing the Patient Discharge Process: Using Quality Improvement Tools to Optimize Hospital Efficiency. Glob J Qual Saf Healthc [Internet]. 2021 Feb 1;4(1):44-9. Available from: https://innovationsjournals.kglmeridian.com/view/journals/jqsh/4/1/article-p44.xml

15. Al Harbi S, Aljohani B, Elmasry L, Baldovino FL, Raviz KB, Altowairqi L, et al. Streamlining patient flow and enhancing operational efficiency through case management implementation. BMJ Open Qual [Internet]. 2024 Feb 28;13(1):e002484. Available from: https://qir.bmj.com/lookup/doi/10.1136/bmjoq-2023-002484

16. Alotaibi Y, Alnowaiser N, Alamry A. Improving hospital flow ‘Ensiab Project.’ BMJ Open Qual [Internet]. 2021 Sep;10(3):e001505. Available from: https://qir.bmj.com/lookup/doi/10.1136/bmjoq-2021-001505

17. Teigen NC, Sahasrabudhe N, Doulaveris G, Xie X, Negassa A, Bernstein J, et al. Enhanced recovery after surgery at cesarean delivery to reduce postoperative length of stay: a randomized controlled trial. Am J Obstet Gynecol [Internet]. 2020 Apr;222(4):372.e1-372.e10. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002937819312347

18. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al. A Reengineered Hospital Discharge Program to Decrease Rehospitalization. Ann Intern Med [Internet]. 2009 Feb 3;150(3):178-87. Available from: https://www.acpjournals.org/doi/10.7326/0003-4819-150-3-200902030-00007

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Published

2026-11-02

Issue

Vol. 3 No. 04 (2026): Journal of Tazeez for Public Health

Section

Articles