Communication failures are frequently cited as contributing to patient care errors and delays, specifically with regards to discharge planning. The common medical model, usually structured as a physician service team, houses patients across multiple nursing units throughout the hospital. This geographical distribution impairs physician to nurse communication and the ability to effectively coordinate the plan for patient’s discharges thus, hindering efficient patient flow.
To implement an effective physiciantonurse communication methodology that was timely, standardized and improved discharge prediction and coordination. The goal was to improve discharge prediction, room turnover, pull time and bed turns.
Utilizing our existing computerized physician order entry (CPOE) system, we implemented a physician order that was to be entered within 36 hours prior to the patient’s predicted discharge. An education plan was developed for physicians, nursing and other disciplines that outlined the process for the “planning order”. The process includes patient and family awareness and education, prioritization of tasks, and follows up communication to the provider. This information was incorporated into existing standard workflow for communicating pending and confirmed discharges and use of a multidisciplinary electronic dashboard. Collectively, these tools serve to enhance communication around discharge prediction and improve reliability. Recent data from JulyOctober of 2011 compared to the same prior period demonstrates a 7.3% improvement in utilization of bed resources, moving from 89.9% occupancy to 96.5%. The reliability of the Planning Order (defined as patient departure within the period defined in the order) has increased by greater than 79% when compared initial Planning Order implementation efforts.
By integrating the “planning order” into standard work, we will be able to interface discharge notification in CPOE from physicians to Teletracking (electronic bed tracking system) used in Patient Placement Center. Sources of waste such as, waiting for test results, waiting for discharge paperwork, etc. have been mitigated. By further refining these interventions; we will improve forecasted bed availability, increase the preassignment of patients to currently occupied beds, and advance reductions in room idle time and waste in the process. Implementation of a physician driven electronic communication order, visible to all stakeholders, enables predication of anticipated discharge time therefore improving overall throughput.
To cite this abstract:Bigio D, Smith E, Stevenson G, Minor L, Gulati M, Reynolds M, Harrington M, Lambert R, Cafeo T. A Systematic Approach to Enhance Communication and Optimize Patient Flow Through the Use of Technology. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97747. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/a-systematic-approach-to-enhance-communication-and-optimize-patient-flow-through-the-use-of-technology/. Accessed September 17, 2019.