The cohesiveness of the discharge process is critical for ensuring the safety and quality of transition of patient care from the inpatient setting to the next level of care. The discharge process is often viewed as chaotic by the health care team as well as patients and families. A few reasons why the discharge process is being viewed as complex and at times disjointed include the declining presence of primary care physicians in hospitals and emergence of hospitalists; lack of consistency in information flow between hospital team and the next level of care team; and patients feeling unprepared for discharge. Certain peridischarge interventions have demonstrated improved primary care physician satisfaction, patient satisfaction, and readmission rates.
This study was conducted on a 50‐bed general medical telemetry nursing unit that served as the test site for inpatient discharge process improvement from January 2008 to December 2008. A multidisciplinary team of physicians, frontline nursing staff, social workers, hospital administration, unit leadership, and personnel from the office of quality who were trained in the Lean methodology were assembled for this initiative. First, the team created a detailed process map, called a Value Stream. This map allowed for the visualization of the entire process flow from admission to treatment to discharge. Second, the team identified 5 areas of delay within the discharge flow. These identified areas became targets for intervention or rapid improvement events (RIEs). RIEs are weeklong activities that are a part of the Lean tool kit and provide a mechanism for making radical changes to current processes and activities within very short timescales. Over the course of 1 year the team participated in 7 RIE initiatives: (1) visual notification of discharge readiness, (2) patient discharge education, (3) standardization of the MD discharge process, (4) demographic and insurance quality, (5) standardization of the RN discharge process, (6) standardization of SW discharge—disposition home, and (7) standardization of SW discharge—disposition skilled nursing facility. The following outcomes were measured: (1) length of stay index (LOS index), defined as a ratio of observed to expected length of stay, (2) physician and RN satisfaction with discharge process before and after the study, and (3) proportion of discharges before 2 PM.
As a result of the intervention, the LOS index had steadily declined from 1.16 to consistently below 1.0 (organizational target is LOS index < 1.0); physician and nursing satisfaction with discharge process significantly improved from the pre‐ to the postintervention state; the proportion of patients discharged before 2 PM increased from 24% to 36%
Lean methodology is an excellent tool for improving the quality and efficiency of the discharge process and should be widely utilized in the health care setting
V. Akopov ‐ none; W. Smith, Jr. ‐ none; S. Thomason ‐ none; K. Graham ‐ none; P. Graham ‐ none; C. Mims ‐ none; S. Mullings ‐ none; K. O’Donald ‐ none