Organizational Factors Affecting a Patient’s Average Length of Stay in Hospital: Systematic Review

Average length of stay (ALOS) is an indirect indicator of resource consumption and a measure of efficiency in hospitals. Therefore, managing the effective organizational aspects can provide opportunities for increasing revenues, reducing costs, improving patient clinical outcomes and quality of care, and increasing profitability. This study aimed to identify organizational factors affecting the ALOS. This was a systematic review using the PRISMA protocol to search literatures in international (PubMed, Google Scholar, Science Direct) and national (SID, Magiran, and MedLib) databases. According to the PICOS strategy, all published papers were retrieved in English and Persian languages until October 2017 using different combinations of keywords such as length of stay, stay length, stay lengths, hospital stay، hospital stays, organizational factors and the Persian equivalent keywords. Final selected papers were critically appraised with the CASP and PRISMA checklist. Finally, factors affecting ALOS were presented in comparative tables. A total of 127 publications were retrieved in the initial step. After screening, 12 full text publications were carefully reviewed. The most important organizational factors affecting the patient's ALOS were the ratio of nurse: patient, training of the physicians and nurses, the patient's discharge process, the presence of a physician in department, the number of para-clinical requests, inter-departmental coordination, time of the first treatment in the ward after admission, visit times, and admission days. These factors were categorized into four groups of process, service, organizational, and human resource factors. Process and management factors are considered the controllable variables of hospital management, therefore senior managers and decision makers in hospitals can focus on these factors to conduct policy interventions in order to improve productivity and the quality of services.