At our tertiary care center hospitalists were charged to improve throughput by discharging patients in a timely fashion. Using Lean methodology, we developed multiple rapid improvement events (RIEs) to tackle various facets of the discharge process. In our initial planning event we found one major issue that delayed discharge was patient preparedness. We obtained baseline data by anonymously surveying patients with three key questions: 1) knowledge of their diagnosis 2) awareness of their proposed discharge date and 3) who were their caregivers in the hospital and what were their roles. We found patients were often unaware who the members of their healthcare team were, especially if they were on a medical resident teaching team. In addition, only 27% of them were aware of their discharge date prior to being told they were going home that day. We found patients and their family members were therefore often unprepared for needed transportation, clothing and home arrangements that needed to be in place for a safe discharge. Lastly, we discovered that patients received mixed messages from the multiple people involved in their care, creating a sense that the care team was not communicating.
We hypothesized that if the patients were informed on a daily basis as to their daily plan of care and anticipated discharge date, they would be more prepared to leave at the designated time. We also believed that if we standardized communication, it would improve patient’s perception of teamwork between the disciplines and create a more unified message for the patient.
All patients have a white board in their room at our facility, but the information on that board is random. We standardized the white boards on a few pilot floors to include date, names of all caregivers including hospitalist team, nurse, case manager and patient care technicion. We also encouraged hospitalists to hand out their photo cards to their patients in order to indentify themselves as the team leaders. In addition, we designed a laminated pink sheet that the hospitalists would fill in daily with key information including the patient’s diagnosis and care plan, and anticipated discharge date. If the patient gave permission, we posted this on the white board. The RN also posted any nursing goals the patient had for the day.
At the start of the intervention, 27% of patients interviewed were aware they were going home prior to the day of actual discharge, after the intervention this rose to 62%. In addition, the patients’ perception of teamwork between care teams as excellent rose from 23% to 31%. The white boards also have become a tool for providing basic communication with families who may visit after hours.
To cite this abstract:Bryson C, Dhungel N, Sittig R, Yadav S. Patient Preparedness for Discharge. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97683. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/patient-preparedness-for-discharge/. Accessed April 8, 2020.