Background: Discharging patients in an efficient manner improves patient satisfaction and hospital throughput. In this project, we sought to improve patient throughput as well as benefit resident education. Prior to our project, 75% of patient discharges were delayed more than two hours after the patient was determined to be medically ready for discharge; 21% were due to the discharge medication reconciliation process and 26% were the result of provider workload issues.
Purpose: To improve efficiency of patients’ discharges and to enhance resident education on the family medicine teaching service at a large academic hospital. Between October 2017 and January 2018, we implemented a multidisciplinary quality improvement project with the goal of decreasing the time between when a patient is medically ready for discharge and when they complete their discharge process.
Description: Using a multidisciplinary team, we analyzed root causes of discharge delays and determined multiple potential interventions. We began by process mapping the discharge process with nursing, residents, patients, and pharmacists. This helped us determine the areas in our workflow that might benefit from improvement. Two areas emerged as likely highest yield. We recognized we needed to improve the amount of reworking pharmacists had to perform on the resident’s discharge orders as well as improve communication with regard to prioritizing patient discharges. To achieve these goals, we implemented two interventions. First, we moved the pharmacist’s workspace into the same physical location as the resident’s workspace. Second, we established a daily meeting between pharmacist and residents to prepare the discharge medication reconciliation for the following day. Pharmacist and resident team-members were able to adhere to the meeting schedule approximately ten days per month. In the meetings, the pharmacist and residents reviewed 1-3 patients and the meetings lasted an average of 18 minutes.
Conclusions: We recorded “Discharge Delay”, the time between resident placement of the final discharge order and pharmacist completion of medication reconciliation review and patient education. After implementing both pharmacy-based changes, Discharge Delay decreased from 72.7±58.4 to 47.6±37.4 minutes (p=.002) in just one month. Number of electronic pages sent between pharmacist and residents also dropped from 118 to 14 in a one month time period, an 88% decrease. Through a qualitative survey, pharmacists and residents reported increased satisfaction and perception of educational benefit. The pharmacy discharge assistance meetings and geographic co-location interventions were simple to implement, appear to improve patient flow, may be beneficial to residents’ education, and offer an example for improvement on other resident-based services in an academic hospital system. Future studies will determine the impact of each intervention individually and whether or not patient safety was impacted.