Background: Due to the complexity of patient discharge needs leading to increased length of stay within a large academic medical center, a specialized inpatient unit became a priority.
Purpose: The University of Kentucky Healthcare created the Complex Discharge team to identify and manage patients who may have a long length of stay, a challenging placement and/or complex discharge needs.
Description: We created bed capacity by cohorting complex discharge needs patients on a single twelve-bed nursing inpatient unit. A collaborative team consisting of a registered nurse, nurse manager, nursing director, assistant chief nurse executive, advanced practice provider, hospitalist physician, and social worker established an algorithm containing inclusion and exclusion criteria for patient’s acceptance to this team. Patients no longer requiring active consults, anticipated wait for discharge > 5 days due to placement or resources, discharge disposition is unknown, guardianship to be determined, needs inpatient IV antibiotic therapy > 5 days are the main inclusion criteria. The patients are admitted to a single medicine team and are managed by a dedicated advanced practice provider, social worker, recreational therapist in collaboration with the nursing staff. Eligible patients are identified by the social worker in collaboration with the primary care teams, patients, and their families and then patients are transferred to this unit. Daily expectations of the interprofessional team include huddles and participation in bedside rounding with the patient and family as the central focus. Post-round huddles are conducted to determine priorities, for active participation in screening patients for admission. Standard documentation is done every twenty-four hours with updates as needed to the plan of care.
Results are analyzed for the time period between August 2015 – July 2017. Patients average case mix index is 2.56 with an average length of stay of 51.26 days leading to 289 discharges. The decrease in daily direct costs is $790.91 with a monthly cost avoidance of $231,736. Total program cost avoidance is $6,487,013. Employee engagement results increased to 4.03 an increase of +0.39 from 2016. Due to this success, we now have expanded this from a 12 to 23-bed unit.
Conclusions: Specialized complex discharge team to care for patients with complex discharge needs in a large medical center leads to significant cost avoidance