Kaiser Foundation Hospital-Roseville Schedules Patient Discharges to Improve Throughput

This improvement story originally appeared in IHI's 2006 Progress Report.
 
It makes sense when you think about it. Hotels establish a check-out time so they can plan for the next wave of visitors. Why can’t a hospital do the same?
 
Discharge appointments are one of the tools IHI recommends for improving the flow of patients into, through, and out of the hospital. Kaiser Foundation Hospital-Roseville in Sacramento, California, a participant in the Transforming Care at the Bedside initiative, has put this and other flow improvement tools to good use.
 
Patients at Kaiser-Roseville were sometimes “parked” in the Emergency Department or in recovery after surgery while they waited for a bed. “It was a huge patient dissatisfier,” says Sandy Sharon, RN, MBA, Assistant Administrator for Patient Care Services. Analysis of patient flow revealed that most discharges and admissions occurred on the evening shift. “So we set a goal of having 40 percent of discharges occur before 11:00 AM,” a goal the hospital achieved in October 2005.
 
Now, discharge rounds are conducted daily at 11:30 AM to start the ball rolling for the next day’s discharges. “We identify patients we think will be discharged the next day, and get any pending lab work going, get orders for discharge meds into the pharmacy, notify the family, and tie up any loose ends. PT knows which patients to see first the next morning. Housekeeping knows which rooms will turn over and when. It really benefits everyone.”
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