Background: During the initial COVID-19 surge in the Spring of 2020, adequate inpatient bed availability was a key factor in determining the quality of the care provided to our patients. Timely and efficient daily discharges were vital to creating bed capacity and decompressing access points. At our institution, an 800-bed tertiary care medical center outside of New York City, the centerpiece of our discharge planning process has historically been our morning interdisciplinary rounds (IDRs). Traditionally, these rounds took place only on the weekdays, and were performed in an in-person, group setting. Over time, medical units engaged in the IDR process have shown gradual improvements in measures of throughput and efficiency. However, this process has been notably absent on the weekends, corresponding with decreased discharge volumes and increased bed constraints.
Purpose: In order to maintain appropriate social distancing and further enhance our collaboration on the weekends, a “Weekend IDR” process was created. Our goal was to create an easily accessible, high-yield forum for interdisciplinary communication on the weekends in order to improve our discharge rates.
Description: Interdisciplinary meetings involving hospital medicine, advanced clinical provider (ACP), nursing (RN), and care coordination (CC) leadership began in June 2020. A transparent review of each discipline’s staffing and weekend capabilities were discussed, as well as an understanding of high-yield items for discussion. Six medical/telemetry units were identified for participation. On Friday afternoons, patients identified as potential discharges on those units have a “Prepare for Discharge” order placed in our EMR. Rounds take place on Saturdays and Sundays from 10A-11A. In addition to the aforementioned disciplines, physical therapists and pharmacists also participate. Rounds take place remotely via Microsoft Teams, led by a single hospitalist. Only patients with an active Prepare for Discharge order are discussed. ACPs for each unit present the pertinent clinical history and discharge plan, with input provided by the RN and CC as needed. The hospitalist summarizes the case and memorializes the plan within the EMR, which is accessible by all participants thereafter. Items identified for escalation, such as testing or other barriers to discharge, are addressed in real-time by the team.
Conclusions: Approximately 45 cases are discussed during each session, taking about 1 minute per case, with an increase in cases discussed noted month-over-month. 75% of the cases discussed are ultimately discharged by the following Monday; this number is increased as compared to units not participating in the IDRs. During the first three months of our process, we have noted a 26% increase in the number of weekend discharges from our weekend IDR units as compared to the same three-month period in 2019; overall inpatient volumes were comparable during the two periods. Five of the six units have demonstrated improved overall excess days per case. Our interdisciplinary teams see value in the process and feel it is not an overly burdensome time commitment; focusing discussions only on those patients nearing discharge has been well received. The remote nature of rounds has maintained social distancing. We plan to expand the process to other units and continue to adjust as needed in order to meet the demands of the changing clinical landscape.