Abstract
Background: Yishun Health (YH) is a regional hospital system in the north of Singapore. Analysis of YH systemic patient segmentation revealed that low acuity and low needs patients constituted over half of emergency admissions, significantly impacting bed occupancy. To address this, Medical Short Stay Wards (MSSW) were introduced to improve outcomes, staff satisfaction, and system efficiency. The MSSW aims to provide integrated and interdisciplinary acute medical care for selected patients within the hospital and discharge them within 72 hours. This study evaluates the effectiveness of MSSW in reducing hospital length of stay (LOS) and healthcare costs and improving patient outcomes.
Methods: Service evaluation was conducted to compare patients admitted to MSSW with those admitted to other medical wards with similar needs. Clinical, cost, and patient outcome indicators were used for this evaluation including Average Length of Stay (ALOS), Average Gross Amount, 30-day readmission, and others such as inpatient mortality, % of cases exceed norm cost, etc.
Results: From July 2024 to September 2024, MSSW admitted 528 patients, characterized by younger age and lower Charlson Comorbidity Index (CCI). The majority were low acuity (Patient Acuity Scale P2 & P3) cases, with a small proportion (5%) being high acuity (P1) cases. The ALOS for MSSW patients was 3.8 days, compared to 6.6 days for patients in normal wards (p<0.05). The average gross amount for MSSW cases was SGD$5,229, significantly lower than SGD$9,971 for normal ward patients (p<0.05). 30-day re-admission rate among MSSW cases was also lower compared with normal wards (9% v.s. 13%, p<0.05). The overall transfer rate from MSSW to normal wards was 20%, with transferred cases exhibiting a longer ALOS compared to those initially admitted to normal wards (8.2 days v.s. 6.6 days, p<0.05). Higher transfer rates were observed among high acuity and high needs patients.
Conclusion: The MSSW successfully reduced overall ALOS and healthcare costs, as well as lower 30-day readmission rate for patients admitted to the ward, achieving its intended outcomes. However, to further enhance its effectiveness and system-wide impact, MSSW should refine its target population and inclusion criteria based on patient acuity and needs to minimize transfer rates. Ongoing programmatic evaluation and performance tracking are essential for continuous service improvement.
Implications for Integrated Care: The findings underscore the potential of MSSW in optimizing healthcare resource utilization and improving patient care experiences. By refining patient selection criteria and continuously monitoring performance, MSSW can serve as a model for integrated care initiatives aimed at enhancing hospital efficiency and patient outcomes.