Among them were patients with congestive heart failure, for which patients were spending an average of six or seven days in early 2002, well above industry norms. Interviews with cardiologists revealed a nagging problem of one-day or two-day waits for ultrasound results, which are needed to update a patient's condition before discharge. In response, the Department of Radiology agreed to a policy of "same-day" discharge service for ultrasound procedures and revised its lab hours when necessary to accommodate the workload. As a result, length of stay fell to an average of 4.7 days by early 2003, below the Millman average of 4.8 days. The radiology department went even further, altering its consultation schedule to fit demand and alleviate backlogs and moving to a seven-day-per-week schedule for elective, or non-emergency, cases.
Perhaps the most dramatic example was applied to patients needing intravenous infusions because they were experiencing organ rejection after transplantation, or as part of their treatment for lupus. Before 2002, patients were admitted to Hopkins while they underwent once-daily infusions, which must be performed by a nurse. Treatment periods sometimes lasted as long as 14 days. Finding these extended wait times inconvenient for patients, the Hopkins team established an outpatient intravenous center, allowing patients to go home after one or two days before having to return to the hospital as outpatients for their remaining infusions.
"Same-day" or "48-hour" consultation service policies were introduced for other procedures, such as visits by social workers to patients newly diagnosed with HIV, and performance of colonoscopies and cardiac catheterizations.