Background: Unimpeded patient flow enhances quality, patient experience and access, while reducing costs. Our hospital has an in house discharge pharmacy, which allows us to send patients home with their imperative medications prior to discharge. About 53% of our discharges were delayed due to discharge medications, which equates to 27.8 hours for the ~30 daily discharges. The ZSFG pharmacy processed medications in the order received with an average medication filling time of 71 minutes, and nonstandard communication amongst providers. Hourly medication deliveries without clear communication of delivery led to an average 114 minute delivery time. The total process of when the medication order was first ordered by a provider to when it was delivered to the patient (defined as total lead time) was about 185 minutes, with an estimated 21% of this being value added.

Purpose: We aimed aimed to decrease lead time from 185 to 90 minutes by applying lean management principles. We also focused on decreasing medication-related discharge delays from 53% to 25%.

Description: We integrated the anticipated date and time into the discharge medication order, translating into visual management color-coded bins in the pharmacy to prioritize early discharges. Standard work for technicians and pharmacists minimized non value-added time and allowed increased frequency of medication deliveries to units. Verbal communication to unit nurses at delivery minimized waiting.
These interventions decreased the total lead time to 118 minutes, reduced medication-related discharge delays to 18%, and eliminated ~21.7 hours of patient waiting per day.

Conclusions: Analysis of cross-departmental processes reveals multiple opportunities for waste reduction. Careful alignment of production timing to patient demand can reduce delays. Standard work and visual management systems are critical to ensure new processes persist. Small decreases in care processes at discharge result in significant increases in hospital capacity. Future improvement will focus on reducing defects originating at the point of order.