Patient Care

Inpatient Navigators Reduce Length of Stay without Increasing Readmissions


 

Clinical question: Does a patient navigator (PN) who facilitates communication between patients and providers impact hospital length of stay (LOS) and readmissions?

Background: Increasing complexity of hospitalization challenges the safety of care transitions. There are few studies about the effectiveness of innovations targeting both communication and transitional care planning.

Study design: Retrospective, cohort study.

Setting: Single academic health center in Canada, 2010-2014.

Synopsis: PNs, dedicated team-based facilitators not responsible for clinical care, served as liaisons between patients and providers on general medicine teams. They rounded with medical teams, tracked action items, expedited tests and consults, and proactively served as direct primary contacts for patients/families during and after hospitalization. PNs had no specified prior training; they underwent on-the-job training with regular feedback.

Researchers matched 7,841 hospitalizations (5,628 with PN; 2,213 without) by case mix, age, and resource intensity. LOS and 30-day readmissions were primary outcomes. Hospitalizations with PNs were 21% shorter (1.3 days; 6.2 v 7.5 days, P<0.001) than those without PNs.

There were no differences in 30-day readmission rates (13.1 v 13.8%, P=0.48). In this single center study in Canada, the impact of PN salaries (the only program cost) relative to savings is unknown.

Bottom line: Inpatient navigators streamline communication and decrease LOS without increasing readmissions. Additional cost-benefit analyses are needed.

Citation: Kwan JL, Morgan MW, Stewart TE, Bell CM. Impact of an innovative patient navigator program on length of stay and 30-day readmission [published online ahead of print August 10, 2015]. J Hosp Med. doi: 10.1002/jhm.2442.

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