Background:
Multidisciplinary rounds, geared toward reviewing patients’ readiness for discharge, are performed daily throughout our large academic medical center. Standardization of these rounds was made a priority in order to promote patient safety and efficiency. As hospitals become more complex and teams become larger, it is more important than ever to ensure all providers are on the same page. To this end, we developed a Quality Dashboard that pulls information directly from the EMR in real time.
Purpose:
The Quality Dashboard allows every member of the team to quickly identify and act on relevant information, including who are the patients who have been readmitted within 30 days, who still has a urinary catheter, who has been hospitalized for over 5 days. Additionally, we developed a place to document a brief “Four Questions” summary of the status of the patient as it relates to readiness for discharge, again assuring all providers have a shared mental model about the patients’ expected disposition.
Description:
We initiated the Quality Dashboard in July 2014. Large screen monitors were purchased and installed in the back of each nurses’ station, the location for multidisciplinary discharge rounds. All team members refer to the Quality Dashboard during these rounds. The patient characteristics that we chose to display on the dashboard are: patient name and location, demographics, care providers, date of admission, readmission within 30 days, patient class, code status, VTE prophylaxis, code status, pain score, telemetry orders, admit order information, ambulation assist level, and ambulation distance.
The “Four Questions” included: Why is the patient hospitalized (Principal Problem)?, Why is the patient STILL hospitalized?, What are the barriers to discharge? Where and when is the patient going to be discharged safely? While the use of the Quality Dashboard was one of many measures undertaken to promote value, our O:E LOS decreased from 0.98 (the six months before initiation of the dashboard) to 0.89 (the six months after initiation).
Conclusions:
The Quality Dashboard and the “Four Questions” are sustainable and achievable systems innovations that add value by ensuring all providers have a shared mental model about every patient’s safety goals and disposition plan. By providing real-time information to all providers, the Quality Dashboard helps the ever-growing team make the best decisions for our patients. Streamlining care is reflected in our improved observed to expected length of stay (O:E LOS).