Using a Systematic Framework of Interventions to Improve Early Discharges.
BACKGROUND
Late-afternoon hospital discharges can lead to admission bottlenecks and negatively affect the flow of patients needing hospital admission. Delays in discharge are a prevalent health care problem and have been linked to increased length of stay, lower patient satisfaction scores, and adverse outcomes. As a result, hospitals are placing a renewed emphasis on early discharge as a way to reduce admission delays and achieve optimal patient flow. This study shows that the Model for Improvement (MFI) is an effective approach for complex improvement efforts.


METHODS
A needs assessment identified four common barriers to early discharge: (1) lack of communication between nurses, case managers, and teams about discharge planning; (2) obtaining home services, equipment, and oxygen early in the morning; (3) arranging transportation to facilities earlier in the day; and (4) communicating discharge expectations with patients and family members. Using the MFI, we tested and implemented interventions in three key areas: education, process changes, and audit and feedback. Key interventions included an educational campaign on the safety implications of reducing emergency department boarding time, an afternoon huddle with MDs and case managers, and a Web-based dashboard to provide real-time discharge by noon (DBN) audit and feedback.


RESULTS
The DBN rate increased from a baseline of 10.4% to an average of 19.7% during a 24-month time frame, with significant improvements in average length of stay (5.88 to 5.60) and length of stay index (1.18 to 1.10) (p <0.05).


CONCLUSIONS
Improving hospital throughput is becoming imperative, and a structured approach to improvement can lead to rapid and sustainable results.
Hemali
H
Patel
Sasha
S
Morduchowicz
Michelle
M
Mourad
D002140:California; D017144:Focus Groups; D006739:Hospital Administration; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay; D020380:Needs Assessment; D010348:Patient Care Team; D010351:Patient Discharge; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires