Background: ED (Emergency Department) boarding refers to patients who remain in the ED after they have been admitted. ED boarding is associated with decreases in quality of care, patient safety, and satisfaction. UAB has a longstanding, substantial problem in regards to ED boarding.Discharging patients late in the day from inpatient units contributes to ED boarding by misaligning bed availability and bed need ((ACEP), 2011).
Methods: Improving inpatient discharge efficiency will reduce ED boarding, hence improving quality, patient safety, and satisfaction. A unit based interdisciplinary Accountable Care Team (ACT) has been shown to be an effective way to improve a unit’s quality (Kara, Johnson, Nicley, Niemeier, & Hui, 2015). P9 is a 20 bed hospitalist inpatient unit at UAB. P9 formed UAB’s first ACT, and their initial project focuses on improving discharge efficiency. Success of the project will be measured by increasing discharge efficiency (P9 patients discharged before 1 pm) from a baseline of 22% per month to > 50% per month.Formation of a Unit-based Accountable Care Team (ACT)- Weekly interdisciplinary frontline team improvement meetings- Meetings are collaborative, engaging, innovative, and action oriented- Constructive problem-solving methodology- Incremental weekly improvement cycles- Involvement of domain experts from collaborative servicesUnit-Based Physicians- Limited to 6 Hospitalists (self-selected)- All shifts covered by these physicians, in collaboration with an APP- Physicians agree to: participate in improvements; read and engage in pertinent email; review performance data
Results: Outcomes:Discharges before 1PM per month have increased from a baseline of 22% to 54% (average last 6 months), without changing CMI-LOSP9 ACT members recognize the substantial benefits of teamwork and have felt a greater sense of empowerment, engagement and value
Conclusions: Conclusions:An ACT is an effective and rewarding way to improve hospital unit qualityForming ACT’s throughout the hospital which focus on discharge efficiency will decrease the number of ER boarders
