Background:
Delayed discharges from the hospital can negatively impact hospital throughput by preventing new patients from accessing beds. At Stanford Hospital & Clinics (SHC), the median discharge order time was 13:16 and median discharge time was 15:40 in Q4 2004 on the inpatient medicine service. Barriers to early discharge include culture shift, difficulty predicting discharge date and time, and multiple factors/groups involved in the discharge process. Our question is whether interdisciplinary communication and preparation among MD, staff, and patient/family can lead to earlier discharge times.
Method:
Our objective was to design interdisciplinary discharge processes and to define hospitalists's responsibilities to increase patient throughput on the inpatient medicine service as measured by:
1) Decrease in median discharge order entry time
2) Decrease in median patient discharge time
Project success will be determined by improvement:
1) Over the hospitalist's prior year performance
2) In comparison with current non‐hospitalist medicine service
A multidisciplinary process excellence team used a 90‐Day Rapid Results Model from 6/05‐9/05 with monitor phase in 10/05. After reviewing the literature and mapping out the current process at SHC, key process changes we sought to improve:
1) Formal MD communication on admission to staff/patient/family regarding estimated discharge date and discharge needs
2) Afternoon rounding by the Hospitalist with the housestaff and standardized approach to discharge during AM
3) Resource nurse/case management and housestaff morning rounds
4) Creation of an anticipated discharge order in the computerized physician order entry to alert staff of pending discharge
5) Use of central white board for communication of discharge date
6) Revised nurse discharge planner and new checklist
7) Increased emphasis on preparation and early discharge orders during housestaff orientation and hospitalist attending rounds
Summary of Results:
Data from 10/05:
1) Hospitalists entering discharge orders 2.5 hours earlier than last year Hospitalists patients discharged 2 hours earlier than last year
2) Hospitalist entering discharge orders 1.3 hours earlier than the rest of medicine Hospitalist patients discharged 1.3 hours earlier than the rest of medicine
Statement of Conclusions:
1) Cross functional communication key to coordinating care of the patient for discharge
2) Early notification of patient, family, and staff allows for proactive preparation for discharge
3) Important to have attending hospitalist drive process, but also need support of interdisciplinary team and hospital administration
4) Bi‐monthly data motivating to all parties involved
5) Opportunities to improve include facilitating transport home & expediting tests and procedures
Author Disclosure Block:
L. Shieh, None; B. Gavi, None; K. Posley, None.