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.