Transforming Healthcare

Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit




Optimizing hospital operations is a critical issue facing healthcare systems. Reducing unnecessary variation in patient flow is likely to improve efficiency and optimize capacity for hospital inpatients. The objective of this study was to determine whether changing admissions, from a “bolus” system to a “drip” system, would result in a smoothed daily discharge rate, and reduce the length of stay of patients on a General Internal Medicine clinical teaching unit over a period of 1 year.


We conducted a retrospective analysis of the General Internal Medicine inpatient service at Toronto General Hospital for the 6‐month periods from March to August during 2 consecutive years. Length of stay distributions and daily discharge rate variations were compared between the 2 study periods.


There were a total of 2734 discharges, 1446 occurring in the pre‐change period, and 1288 in the post‐change period. There was overall smoothing of the daily discharge rates, and a reduction of 0.3 days in median length of stay in the post‐change period (P = 0.0065).


Restructuring the admission system to achieve constant daily admissions to each care team resulted in a smoothing of daily discharge rates and improved operational efficiency with shorter lengths of stay. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

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