No one enjoys staying at the hospital for longer than necessary. It’s an all-too-common scenario that a patient is ready to leave, but gets delayed because of a pending medical clearance or a transportation issue.
Timely discharges don’t only serve the best interests of the patients going home, they also allow the hospital to accommodate new patients, providing a sick patient with a bed in a medical unit that would otherwise have been filled to capacity. Moreover, clinicians who discharged patients in the morning are able to devote their full attention to new admissions in the afternoon.
More often than not, discharge delays are preventable. Coordinating among a team of social workers, nurses, physicians, and physical therapists can improve the efficiency of hospital discharges. Just as treating patients is a holistic process, discharging them is one as well. But morning discharges are easier said than done, and many medical units could improve their processes.
In order to address this issue, I joined in the efforts of Dr. Hyung Cho, the Director of Quality and Patient Safety in the Division of Hospital Medicine at the Mount Sinai Medical Center. We worked on a QI initiative on inpatient throughput, utilizing the Dartmouth Clinical Microsystems Assessment Tool
with an inpatient unit. This analysis method involves comparing our own microsystem to an ideal system, demonstrating characteristics such as patient focus and interdependence.
We began streamlining the pre-discharge process in April 2014. Our team asked nurses to keep a daily log of next-day discharges divided into two categories: patients who were certainly leaving and patients who had pending issues that needed to be resolved before they could be discharged. In this way, we managed to keep track of the most common hindrances to early discharges. Moreover, documenting discharge times on a daily basis contributed to the nurses’ awareness of this issue, which in turn led to increased cooperation between them and social workers, physicians, and physical therapists. We used PDSA cycles to improve the quality of care patients receive at Mount Sinai. By the end of the four-month intervention, we increased discharges before noon by 73 percent, and allowed for more accurate discharge communication and less time wasted in failed discharge attempts.
Quality improvement is a constant quest, since there is always progress to be made. However, we are hopeful that our project will inspire lasting change.