2347 EXPEDITE: a sustainable initiative to improve average length of stay (ALOS) in an acute geriatric Ward in Singapore

Abstract Introduction Prolonged hospitalisation is associated with increased mortality, increased risk of hospital acquired infections, functional decline and institutionalisation in older adults. Baseline data collected for patients admitted to the Acute Geriatric ward of Alexandra Hospital, a tertiary hospital in Singapore, from 28 Feb to 31 Aug 2022 (n = 299, age > 65 years) revealed an average LOS of 12.3 days. Potential contributing factors identified • 98% did not have a documented medical clearance date • 3.54 days required to decide for medical social worker referral • 9 days before discharge plans are communicated to family. Aim: To reduce average length of stay (ALOS) from 12.3 days in Aug 2022 to 9.81 days by Aug 2023. This was a target set at the hospital level on our Geriatric service in the setting of a rising national pressure for inpatients beds. Method The EXPEDITE Huddle was a regular 30 minute huddle introduced, in addition to the existing weekly multidisciplinary meeting. It was developed based on the QI methodology and streamlined from 3x/week frequency to 1x/week following PDSA cycles. A chat group on the secure hospital mobile phone messaging system was also created for ease of communication among stakeholders. Results • ALOS reduced from 12.3 days to 9.1 days (3.4 days) • 91.8% of patients (n = 154) now have a documented medical clearance date • Communication on discharge plans initiated within 3 days from admission • Sustainability: -In light of positive results, a discharge care navigator (DCN) to lead the discharge planning efforts was offered by the hospital to the Geriatric service. -The EXPEDITE huddle (now led by the DCN) continues and ALOS has remained within target. Conclusion(s) Early discharge planning with a focus on system level factors that contribute to delayed discharge can help reduce ALOS in hospitalised older adults.