Background:
|
Late discharges are a known barrier to patient flow. Our project was to identify barriers to early discharges and develop processes to increase early discharges from the inpatient medicine teams. Purpose: |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
“Daily afternoon multidisciplinary team huddles will increase the % of discharge orders before 10am by 10% on the medicine teams by June 2015” |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Description: We initially analyzed reasons for late discharges on two medicine teams. Using this data, we then planned interventions for all medicine teams that addressed the major barriers identified. Interventions included afternoon multidisciplinary huddles with the attending physician, case manager and resident physician as well as early rounds by the attending and resident physicians for patients scheduled for discharge.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Results: Intervention
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Conclusions: The goal of early discharges is to improve patient flow without compromising the quality of the discharge. Daily afternoon huddles allow teams to identify discharge needs earlier. The team is able to complete medication reconciliation, discharge teaching and coordination of discharge care the day before discharge. Discharge orders can then be placed by 10am. Our balancing measures of LOS and readmission rates remained stable which show that patients are not being held an extra day for an AM discharge. Resident work hours were measured and remained stable throughout indicating that this process did not represent added work or time. The teams noted that the process had to be attending physician driven to ensure that daily afternoon huddles occurred. Multidisciplinary team huddles are a key component in hospital medicine and can help with early discharges. We increased early discharge orders by 10% which may not be a large enough increase to show discernible change in ED LOS. Plans are underway to expand this process to other units and services. With further expansion, we hope to improve ED LOS as well.
|