provide more of it without long wait times and to the better satisfaction of the patients we serve," says JHH physician in chief Myron Weisfeldt, M.D., who also is a professor and director of the Department of Medicine at The Johns Hopkins University School of Medicine. "Our next step is to strengthen this program as part of the management culture within Hopkins and to see if other hospitals can adopt our efforts to form the basis of a national program."

Weisfeldt noted that "spending four or five days in the hospital is not uncommon for many patients and for a variety of illnesses and conditions, but we need to question whether or not it is really necessary to spend so much time in an acute-care setting."

Indeed, he added, "most patients would rather not be in a hospital, preferring to return home as quickly as possible and, provided that it is safe to do so, to finish recuperating in the comfort of their own surroundings." The goal, Weisfeldt says, is to provide the best care, and "sometimes that means longer stays, sometimes not."

Historically, the dilemma for physicians and patients, he says, has always been to determine when it is best to leave the hospital, confident that the patient is on a road to recovery and that the patient's care has been delivered in the most effective and efficient manner possible.

Fiscal pressures compound the dilemma, with government, private payers and regulators eager to justify time spent and keep expensive hospital stays to a minimum. An average day of hospital care can cost $1,500.

"It is a tough judgment call that requires more than medical training; it requires constant questioning and review of how we manage a large hospital, practice medicine and treat our patients," says kidney specialist Paul Scheel Jr., M.D., an associate professor and vice chairman of medicine at Hopkins.

To put some evidence behind long-held suspicions that patients could be served better with a
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Contact: David March
dmarch1@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
19-Sep-2005

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