Dr. Dorota Gardy, Psychiatrist
Dr. S. Sarakanti, Psychiatrist
Linda Krossber, Intake Coordinator
Haywood Phillips, Social Worker
John Estabrook, Social Worker
Robert Smith, PA
Patricia Smith, RN, Nurse Manager

Monitor - Track Days Saved

Data:

• Patient identifier
• Provisional length of stay
• Expected transition date
• Actual transition date
• Comment
  • As planned
  • Number of days early
  • Number of days over
• Provider
• Keep running tally of days saved          

Determine Provisional length of stay per diagnosis:

• Historical length of stay data from August 2003 - January 2004, a six month period, compiled and compared
• Length of stay by psychiatric diagnosis reviewed
• Psychiatrists determined a “reasonable” provisional length of stay by psychiatric diagnosis.
  • Schizophrenia — 12 days
  • Schizoaffective disorder — 15 days
  • Bipolar affective disorder  —  12 days
  • Alcohol dependance — 10 days
  •  Depressive disorder — 10 days
  • PTSD — 10 days
• Provisional length of stay documented in report of contact by intake coordinator
• Transition date discussed with patient by psychiatrist.
• Provisional transition date posted on large white board in conference room, following initial report to treatment team by nursing staff.
• Provisional transition date posted in patient room by nursing staff.
• Visual reinforcement of provisional transition date posted in patient room.
• Listing of patient’s providers & room location.
• Provisional transition date reviewed during initial treatment planning for each patient.
• All provisional transition dates noted on a large desktop calendar, kept in the conference room and referred to daily.  Transition dates revised as needed.

• March 2004
  • 38 patients discharged, using new process.
  • 79 percent of these patients were discharged on or before the original transition date.
  • 94 provisional length of stay days saved.
• April 2004
  • 29 patients discharged, using new process.
  • 86 percent of these patients were discharged on or before the original transition date.
  • 74 provisional length of stay days saved.
• May 2004
  • 24 patients discharged, using new process.
  • 75 percent of these patients were discharged on or before the original transition date.
  • Two provisional length of stay days saved.
• Teamwork is essential for success in implementing the transition date plan.
•  “Champion” needed to insure that the steps of the process are completed for each admission.
• Increased communication, verbal & visual, can impact by reducing the length of stay.

Patricia K. Smith, RN, Head Nurse
Behavioral Health Inpatient Unit,
VA Medical Center
Patricia.Smith5@med.va.gov

[Storyboard presentation at IHI's National Forum, December 2004]