By Jack Gottlieb, Aalia Khawaja, Karen Teitelbaum, and Alan Channing 

Using a DRG-based tracer approach, Mount Sinai Hospital decreased length of stay for chest pain patients by 0.48 days in one calendar year and saved nearly $317,255.

Chicago's Mount Sinai Hospital (MSH) was facing compounded challenges: a Medicaid- and uninsured-dominated payer mix, inadequate and delayed government reimbursement, and aging facilities. MSH's performance improvement team perceived that one of the best strategies for meeting these challenges would be to focus initially on identifying opportunities to reduce length of stay (LOS).

The team found that a DRG-based tracer approach, which analyzes and corrects inefficiencies in the flow of care delivery, offers a particularly effective way to meet this challenge. The team also understood that this analytical approach works best when the analysis is focused on a high-volume diagnosis related group (DRG).

To maximize the benefits of process flow improvement, therefore, the team decided to focus on identifying opportunities to reduce length of stay associated with DRG 143: chest pain, due to its high volume and relative high cost of care.


The DRG 143 effort began with key stakeholder meetings. Attendees included clinical and administrative leaders from the emergency medicine, telemetry unit, cardiology, environmental services, transportation, and utilization review departments. As a basis for the analysis, the team created a detailed patient care process flow diagram, including clinical and support departments impacting patient flow, which could be used to identify opportunities for efficiency improvements.

Although the team observed that several factors were influencing length of stay, it decided to focus only on those factors that represented real, actionable opportunities for reducing length of stay and/or improving patient care improvement. The team identified six such factors:

  • Bed availability
  • Bed turnaround (housekeeping)
  • Use of the emergency department (ED) chest pain order set upon inpatient admission
  • Physician practice variation
  • Transportation delays
  • Cardiology department's role on the telemetry unit


In calendar year 2007, MSH admitted 547 patients with DRG 143, with a weighted average length of stay of 2.36 days. At this average length of stay, the average cost to the hospital per patient was $5,144.

As a result of the performance improvement effort, the weighted average length of stay for chest pain patients decreased to 1.88 days in calendar year 2008. The reduced LOS translated to an estimated savings of $535 per patient and an actual total savings of nearly $317,255 for the hospital.

This article is excerpted from a detailed case study by the authors, Achieving Operational Efficiencies Using a DRG-Based Tracer Approach, which appeared in the June 2010 hfm magazine. (Only HFMA members can access this article.)

Jack Gottlieb is manager, material and clinical services, Sinai Health System, Chicago.

Aalia Khawaja is manager, executive analytic service, clinical data and information, University Heath System Consortium Oak Brook, Ill. (authorship occurred during her tenure as director of service lines, Mount Sinai Hospital, Chicago).

Karen Teitelbaum is executive vice president/chief operating officer, Sinai Health System, Chicago.

Alan Channing is president and CEO, Sinai Health System, Chicago. 


Publication Date: Wednesday, July 21, 2010