Purpose: Our mission is to develop a standardized discharge readiness tool and provide education to our Internal Medicine (IM) residents. The aim of this tool and education will also be to increase the efficiency of discharges from the general medicine wards.
Description: Starting in September 2016, we conducted an education innovative on our IM resident ward teams. The first part of this initiative was the development of a Discharge Readiness Checklist for IM residents to identify and prepare patient’s discharges early. The second tool developed was a High Risk-Prior Authorization Medication Checklist. This tool was developed in conjunction with the aid of our inpatient pharmacists. We were able to highlight over 20 commonly prescribed medications that require prior authorization due to limited coverage or high cost. Using these tools, we performed an interactive teaching session with each our five medicine ward teams at the beginning of each month for three consecutive months. We also provided these tools via pocket card handouts and team room posters for continued reference. For evaluation, we conducted a pre and post survey. We have also collected baseline pre and post intervention data on the discharges from these five medicine teams.
Conclusions: Since inception, we have shown an impact both in the education of our IM residents in discharge readiness and in their discharge efficiency. The pre and post survey results were measured on a 5 point scale. Residents increased their ability to identify 6 key areas of discharge readiness from 2.1 to 3.4, as well identify medications requiring prior authorization from 2.3 to 2.8. Residents improved their comfort level in discharge readiness, increasing from 3.3 to 3.7. Residents improved discharge preparation 24 hours beforehand from 3.5 to 3.7. The residents did not show a perceived increase in decreases prior to 12pm; however hospital data shows an impact of our intervention. By that data, we showed an increase in discharges before 12pm, from 6.7% (29/434) to 9% (54/600). Impressively, we were able to decrease the average time from discharge order entry by physician to actual discharge from 4 hours, 23 minutes down to 3 hours, 21 minutes. The metric that remained unchanged was the average discharge time. As balancing measures we tracked average length of stay, mean age and average CMI, all of which were the same pre and post intervention.