The average time of discharge at a hospital is more than the average time of admission and this creates a bottleneck in patient flow. Patients have to wait longer for an available bed. Pushing back the average patient discharge time from late afternoon to morning is vital to increasing efficiency, quality of care, and patient satisfaction.
In our 450 bed community hospital, discharge delay was creating an upstream tidal wave of patient flow constraints which negatively impacted hospital capacity and financial performance. Our 12 physician hospitalist group, providing acute care to about 50% of the adult patients, was tasked to improve this workflow. A metric for measurement of performance was “percentage of daily discharges by 11 AM.”
EHR was adopted at our hospital in fall of 2009. It has a HiMMS (Healthcare Information and Management Systems Society) analytics stage 6 level of adoption. Using this EHR, a “Percentage Discharge by Physician” report was created using the last ADT (Admit, Discharge, Transfer) discharge order by the discharging physician. The data comes from EHR and is pulled by an Infoview/Clarity report. The parameters were Inpatients only. Only patients with same day discharge orders written and discharged. were included Outpatient, Observation, Medical Day bed patients and Expired patients were excluded. Process change: Discharge order written by 11 AM in ADT was achieved mainly by changing rounding patterns of hospitalists and initiating multiple new workflows. (1) Anticipated discharge date by the hospitalist was verbally informed to the treatment team and documented in the progress note. This was added to the “Discharge readiness report” in EH.R (2) Early morning, EHR based rounding from a single point access. (3) Pending tests, consultants notes and ancillary services notes were reviewed. (4) Possible discharges were identified and instructions were conveyed via phone in anticipation of final discharge process. (5) After rounding, medication reconciliation in EHR and teach back was completed on the computer terminal at each patient’s bedside. (6) EHR infoview/clarity based reports, on “percentage of discharges by 11 AM,” were generated for each hospitalist (see graph). A hospitalist team leader was trained to generate these reports locally. Results were displayed in a bar graph format and presented as an open record, to the group, on a weekly basis. This enabled peertopeer comparison. Low performers were easily identified, enabling focused counseling.
Percentage of discharge orders written by 11 AM (for the whole group) increased from 38% to 80% in 4 months. Multiple tools available in EHR enabled hospitalists to change their daily workflow. This improved the number of early discharges resulting in increased bed availability and improved customer (patient and family) satisfaction with the discharge process.
Figure 1Percentage discharge order by 11 AM by physician.
To cite this abstract:Sripada S, Vissa S. Ehr (Electronic Health Record) to Your Advantage: Improving Bed Throughput by Targeting Early Discharges. Utilising Ehr Enabled Worklows and Ehr Based Infoview/ Clarity Reporting Tools. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97743. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/ehr-electronic-health-record-to-your-advantage-improving-bed-throughput-by-targeting-early-discharges-utilising-ehr-enabled-worklows-and-ehr-based-infoview-clarity-reporting-tools/. Accessed May 26, 2019.