Quality Management ApplicationsFocusing on the Medically Ready for Discharge Patient Using a Reliable Design Strategy: A Quality Improvement Project to Improve Length of Stay on a Medicine ServiceMeo, Nicholas MD; Cornia, Paul B. MDAuthor Information Department of Medicine, School of Medicine, University of Washington, Seattle (Drs Meo and Cornia); Department of Medicine, Harborview Medical Center, Seattle, Washington (Dr Meo); and Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, Washington (Drs Meo and Cornia). Correspondence: Nicholas Meo, MD, Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359731, Seattle, WA 98104 ([email protected]). The authors acknowledge Evan Paul, MD, Kari Mae Miles, Connie Morantes, MD, Chris Wilson, Janice Powers, Stephanie Bush, and Marcus Grandjean. The authors have no competing interests to disclose. Quality Management in Health Care: January/March 2022 - Volume 31 - Issue 1 - p 14-21 doi: 10.1097/QMH.0000000000000338 Buy Metrics Abstract Background and Objectives: Length of stay is a common measure of efficiency of care. We aimed to reduce length of stay on a general medicine service through a structured quality improvement project. Methods: A reliable design strategy was implemented in successive stages at a 238-bed academically-affiliated VA hospital. Over a 2-year period, continuous improvement efforts were directed at discrete cohorts of patients deemed medically appropriate for discharge but who remained hospitalized because of discharge barriers. We compared the mean length of stay and medically-ready bed days of care for a hospital in statistical control charts. Pre- and post-intervention comparisons were made using t-tests. Results: In total, 5321 discharges were included in this improvement project, accounting for 35 852 bed days of care. Overall, average length of stay was reduced by 15.7%, from 7.62 to 6.40 days (P < .05). There was a significant reduction in the mean number of medically-ready bed days of care from 2.3 to 1.72. Statistical process control charts demonstrated special cause variation across patient cohorts. Conclusion: A quality improvement project using reliable design principles was associated with shorter length of stay. © 2021 Wolters Kluwer Health, Inc. All rights reserved.