What's happening to linen use in these days of managed care? Few people actually know because many of the old linen-use benchmarks are no longer applicable. It was a simple calculation in the years of high spending on health care, when the average stay per patient was 7.4 days and outpatient surgeries were nonexistent. All you had to do was determine the total amount of clean linen processed during a given period of time and divide that number by the total number of overnight stays. The results were expressed in terms of "pounds per patient day."

Today, however, managed care has turned the tables, and the tried-and-true formulas no longer compute. We rarely talk about overnight stays; instead, the phrase is adjusted patient days, a common term that few in the profession fully understand. It can mean one thing to a hospital with a high census of Medicare and Medicaid patients, and something different to a teaching hospital or tertiary care facility. In general, adjusted patients days reflects a combination of overnight stays and outpatient surgery cases. In many states, three outpatient cases are typically the equivalent of one overnight stay.

Many health care executives assume that a correlation exists between decreased overnight patient days and decreased linen use. This is simply not the case. Two population trends confound this comparison: The population is growing, and the population is aging. The percentage of those over 65 is the fastest growing segment of the U.S. population. The older the population, the greater the likelihood for accidents, medical maladies, general illnesses, and chronic geriatric diseases. And the greater the need for linens.

In 1970, it was fairly common to see linen use close to 15 pounds per patient day. That number started to creep up in the 1980s, as diagnosis-related groups, or DRGs, were implemented nationwide. The linen-use debate has now intensified because everyone is out developing their own special formula for calculating linen use but, the adjusted patient day method has become widely accepted.

Contrary to popular opinion, however, linen use per patient day is not decreasing. It is actually increasing. In 1980, linen use per patient day was 18.3 pounds. In 1990 it was up to 19.2 pounds, and in 1995 it was 22.8 pounds.

What is causing this upswing in linen use at a time when patient stays are actually going down? The number of adjusted patient days is increasing, which results from a drop in the number of hospitals. This began with managed care and is expected to continue. As the number of adjusted patient days continues to climb, the beds in most facilities are being turned more times during the course of a day. In the past, the average daily census benchmark worked well since most beds accommodated only one or perhaps two patients per day. Now many outpatient beds see three to six patients per day in addition to the overnight beds.

The net result is that each bed, on average, is using more linen now than ever before. Couple this with the fact that most hospitals own more physicians practices, which generally receive their linen from the hospital.

One disturbing trend under this scenario is acute linen waste. As more facilities switch to the team concept to deliver patient care, more linen is going into patient areas. With rapid discharges, all of the linen that was taken into the room is frequently considered soiled and is therefore contaminated. As a result, up to 25 percent of all linen that is being returned to the laundry for processing is actually clean and unused. This is hardly the way to reduce linen use and costs.

Many people believe that new, lightweight linen helps to offset those extra pounds entering the laundry. This is yet another misconception. The actual number of pieces used in patient areas is at an all-time high. Because of these conditions, it is incumbent on all caregivers to reduce the amount of linen being used in their health facilities.

Glen P. Phillips is president of Phillips & Associates, a textile management consulting firm in Arden Hills, Minn.

See Developing Your Laundry Business Plan.

This article first appeared in the on December 01, 1996 in HFM online site.

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