A Strategy to Enhance the Discharge Process and Improve Throughput

1Staten Island University, Staten Island, NY
2Staten Island University, Staten Island, NY
3Staten Island University, Staten Island, NY

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 126

Background:

The discharge process is consistently rated among the lowest components of patient satisfaction markers in surveys. Discharge delays and late discharges can also negatively affect throughput by preventing bed availability for new admissions. Barriers include late family pickup times, unanticipated discharge delays, physician lag in discharges, discharge order entry delays, and poor care team communication.

Purpose:

Our goal was to enhance the discharge process by improving communication, satisfaction, and throughput utilizing a multidisciplinary approach with hospitalists and a discharge liaison as facilitators.

Description:

Our 700‐bed community teaching hospital implemented a multidisciplinary pilot project in a 60‐bed wing of the general medical ward to improve the discharge process. Key parts of the project included: (1) hospitalists leading morning work rounds to identify and implement early discharges and (2) the hiring of a dedicated discharge liaison to facilitate the discharges. A discharge liaison is a case manager empowered to enforce all personnel to complete their tasks appropriately and in a timely manner. Hospitalists conducted 8 am morning work rounds with house staff, nurses, and case managers, identifying potential patients for discharge. An order for anticipation of the discharge was then written. During afternoon rounds, the discharge liaison would confirm with the house staff the intent to discharge and request completion of prescriptions, discharge papers, and arrangements for home care and skilled nursing facilities. The discharge liaison would also be responsible for making sure patients and families were notified regarding the anticipated discharge. If labs were needed on the day of discharge, they would be ordered at the 4:30 am lab draw. On the day of discharge, hospitalists were requested to round on their subset of anticipated discharges early and write the discharge order before 9 am. Discharge orders were deemed stat orders by clerical staff, nursing, and case management. Preliminary data during the 2‐month pilot period revealed a decrease in LOS from 6.3 to 5 days the first month and from 7.3 to 5.5 the following month compared with the corresponding months the previous year. A questionnaire survey to patients, nursing, and house staff also revealed improved satisfaction due to this process. Comments made included patients feeling more equipped to make transportation arrangements because they were aware of the time they would be able to leave. Nursing and house staff felt they had better communication with supervising physicians regarding the plan of care for the day.

Conclusions:

Our strategy significantly decreased the average length of stay and enhanced both patient and hospital staff communication and satisfaction with the discharge process.

Author Disclosure:

M. Patel, none; A. Gottesman, none; T. Abdallah, none.

To cite this abstract:

Patel M, Abdallah T, Gottesman A. A Strategy to Enhance the Discharge Process and Improve Throughput. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 126. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/a-strategy-to-enhance-the-discharge-process-and-improve-throughput/. Accessed August 24, 2019.

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