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Improving length of stay: what can hospitals do?

This report by the Nuffield Trust is part of a larger project undertaken by Monitor aiming to find the best ways to improve quality of care across the whole health system in light of recent pressures on the urgent and emergency care system. While reducing emergency admissions is difficult to achieve and hard to sustain, a more effective way to manage the growing demand for beds may be to focus on reducing length of hospital stay – the subject of this report.

There is a significant opportunity to reduce length of hospital stay through improvements in internal processes and the development of alternative services. There are often variations in length of stay, even for patients with similar conditions, and wide variations in the proportion of patients with extended stays. This suggests that improvements could be made. Drawing evidence from the literature together with insights from a number of case studies and a number of senior clinicians and managers, this report explores what approaches to reducing length of stay have been (and could be) effective by providing a set of measures for improving length of stay that are within the control of the hospital itself.

This report complements further work by Monitor published concurrently looking at how to help local health system leaders decide whether to invest in schemes that deliver care closer to patients’ homes.