RESEARCH REPORT | open access

Development and implementation of a multidisciplinary patient-centered protocol to decrease inpatient length of stay and readmissions on the vascular surgery service

Nikolaos Zacharias*, Brandon T. Gaston, Zachary M. Feldman, Tiffany R. Bellomo, Sujin Lee, Aderike Anjorin, Falen Demsas, Bianca Mulaney, Anahita Dua

Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (all authors)
*corresponding author (nzacharias@mgh.harvard.edu)

Received: 01 April 2025; Revised: 28 April 2025; Accepted: 29 April 2025; Published: 23 June 2025

Abstract: Background: Inpatient length of stay (LOS) has become an important outcome measure in hospital performance ratings and quality improvement (QI) initiatives. The 30-day hospital readmission rate has traditionally been used as a counter measure to balance efforts to decrease LOS. Aim: The aim of our QI protocol is to identify common barriers to discharge and enable opportunities for real-time interventions as well as develop strategies to decrease 30-day readmissions. Methodology: We developed a division-based QI protocol based on a weekly LOS “huddle”. Barriers to discharge and real-time interventions were monitored. A multipronged readmission reduction protocol was designed, addressing clinical drivers of readmission. All interventions were implemented in PDSA (Plan-Do-Study-Act) cycles. Interventions aimed to improve patient communication and included a weekly “huddle” reviewing patients with an LOS that was >4 days, barriers to discharge, post-discharge phone calls, mandatory outpatient follow-up within 2 weeks for all groin incisions and ischaemic lower extremity wounds, and protocolized distribution of calling cards with emergency and routine contact information. The primary outcome measure was the inpatient LOS and the 30-day readmission rate. Results: A total of 1,196 patients were include in our study, 473 after implementation of our QI protocol and 723 from the pre-intervention period. The average LOS for all inpatients decreased from 7.1 days to 6.8 days (p=0.015). The 30-day readmission rate decreased from 14.1% to 8.2% (p=0.007). The majority of readmissions, 57% (N=270), occurred within the first 2 weeks after discharge. Conclusion: The development and implementation of a QI protocol to reduce LOS and 30-day readmission (based on the identification of discharge barriers, enhanced patient communication, and more standardized patient follow-up) has shown promising results at our institution. Further efforts to improve the above outcomes should focus on decreasing barriers to patient-provider communication during hospitalization and after discharge.

Keywords: length of stay; multidisciplinary quality improvement protocol; readmission; Vascular Quality Initiative; vascular surgery

Zacharias N., Gaston B. T., Feldman Z. M., Bellomo T. R., Lee S., Anjorin A., Demsas F., Mulaney B., Dua A.: Development and implementation of a multidisciplinary patient-centered protocol to decrease inpatient length of stay and readmissions on the vascular surgery service. Acta Stud. Med. Biomed. 1(1): 5–11 (2025).
https://doi.org/10.5281/zenodo.15721238

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