As the NHS grapples with the dual challenges of shrinking finance and changing population needs, the hospital sector is under particular pressure. Reducing emergency admissions is difficult to achieve and hard to sustain. This project focuses instead on reducing length of hospital stay, which may represent a more effective way to manage the growing demand for beds. Drawing evidence from the literature together with insights from a number of case studies, the Nuffield Trust explores what approaches to reducing length of stay have been effective.

Reducing the pressure on hospital beds is one of the key challenges currently facing the NHS. However, this is not likely to be achieved through reducing admissions – the research literature, not to mention recent attempts by the NHS, suggest that reducing emergency admissions is difficult to achieve and hard to sustain.

Reducing the pressure on hospital beds is one of the key challenges currently facing the NHS. However, this is not likely to be achieved through reducing admissions.

A more effective way to contain the growing demand for beds may be to focus on reducing length of hospital stay. There is a significant opportunity to reduce length of hospital stay through improvements in internal processes and the development of alternative services. Our research and analysis explores what approaches to reducing length of stay have been successful. This has primarily been achieved by detailed review of the literature and case studies of hospital trusts that have demonstrated large and sustained reductions in hospital length of stay.

In addition to some original analysis we carried out to explore the potential pressure on hospital beds caused by population change, one project highlight was an interactive, expert-led seminar that brought together NHS trusts, commissioning groups and experts in the field to share learning and explore ways forward. A report summarising the main findings and a detailed write-up of the hospital case studies was published in September 2015. It highlighted some good practice principles for reducing length of stay, like focusing on patient flow, bundling approaches and devolving responsibility to staff to allow for continuous experimentation and improvement.

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