To address dissatisfaction and inefficiency with the discharge process, in February 2013, we developed a change in our discharge process to focus on two discharge times. This plan was implemented on a general medical unit at Saint Louis Children’s Hospital. The unit’s patient populations include general medicine, sickle cell disease, rheumatology, and infectious diseases. The four months prior to implementing this discharge pilot, the discharge process was rated “Excellent” by families only 40.2% of the time. At the start of this project, there was not a goal discharge time for families. The discharge time was spread from 1000 to 2100, with a mode time of 1300. Our general inpatient team recognized an opportunity for improvement, and collaborated to form a multidisciplinary, hospital‐wide Discharge Process Committee. This committee meets monthly and developed a plan to standardize discharge times with input from families.
To determine major obstacles expediting patient discharges, to understand the impact on patient satisfaction scores, and to improve the mode discharge time. The pilot period ran from Feb – Sept 2013, and compared results with the prior year Feb – Sept 2012.
Historically, a patient was identified for discharge during morning rounds but the families had little input into the time of discharge. During family centered rounds, the family and the medical team now select from two possible discharge times, either an early discharge at 1200 or a late discharge at 1600.
A tracking tool was developed for charge nurses to collect daily discharge information. At the end of the day, this data is displayed on a process improvement bulletin board and is discussed at shift change huddles. This allows staff to identify any emerging trends for missed predictions, as well as celebrate successes.
Education was provided to each resident team on the first day of their rotation to this unit. The assistant nurse manager also provided education to all staff on the new goal discharge times. The percentage of correct discharge predictions was calculated and shared with each resident team, and incentives were provided for improved scores.
The discharge process is complex, requiring coordination with multiple disciplines. The top 3 reasons for not meeting the discharge time goal over the eight month period are: transportation, discharge medications ready, and discharge instructions completed. The discharge time was met 71.2% of the time.
Our patient satisfaction scores have improved by 12.1% for the discharge process and 7.4% for overall quality of care when comparing the pilot period to the prior year (Feb‐Sept). One proposed reason is families are more involved in the discharge process and help select a discharge time that works for them.
The mode discharge time improved from 1300 to 1200 during the pilot period (fig 1). This improvement helps with overall patient flow for the unit and hospital, especially during the busiest months
To cite this abstract:Hrach C, Veile J, Hibbits S, Lane M, Rauscher S. The Discharge Process: It Takes a Team. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 206. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/the-discharge-process-it-takes-a-team/. Accessed March 31, 2020.