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Impact of a Resident-Centered Interprofessional Quality Improvement Intervention on Acute Care Length of Stay

Walker, Megan; Gay, Lindsey; Raynaldo, Glynda; Von Marensdorff, Hans; Bates, Jeffrey T.; Friedland, Joan A.; Park, Jung Hyun; Kehl, Ekaterina; Sowers, Bryan; Bhavani, Sivasubramanium; Lan, Charlie; Bozkurt, Biykem; Stewart, Diana E.; Horstman, Molly J.

The Journal for Healthcare Quality (JHQ): July/August 2019 - Volume 41 - Issue 4 - p 212–219
doi: 10.1097/JHQ.0000000000000156
Original Article

ABSTRACT Competency in interprofessional quality improvement and performance measurement is required by the Accreditation Council for Graduate Medical Education. We implemented an interprofessional quality improvement project to support trainee involvement in systems-level improvement to reduce hospital length of stay and engage trainees in efforts to improve the validity and reliability of clinical documentation contributing to risk-adjusted performance measures. The intervention had three components: daily interprofessional disposition huddles to discuss discharge needs, medical documentation curriculum to improve clinical data accuracy, and scheduled coding huddles to provide real-time feedback on documentation. Outcome measures included an unadjusted and risk-adjusted measure of hospital length of stay. Case severity index (CSI) served as a process measure. Statistical process control charts were used to measure change over time. The mean unadjusted length of stay decreased from 5.84 to 4.98 days. Both the unadjusted and the risk-adjusted length of stay measures exceeded the lower control limit of the statistical control chart. The CSI increased and exceeded the upper control limit of the statistical control chart. Improvements were sustained in the year following implementation. The intervention offers a model for academic institutions to satisfy new Common Program Requirements by engaging trainees in performance measurement and interprofessional improvement efforts.

For more information on this article, contact Molly J. Horstman at

Supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413) at the Michael E. DeBakey VA Medical Center, Houston, TX.

The authors declare no conflicts of interest.

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© 2019 National Association for Healthcare Quality
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