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Improving the Discharge Process at Mount Sinai Medical Center

By IHI Open School | Friday, May 1, 2015
In the following essay, Sigal Israilov, a student at the City of New York Macaulay Honors College and the Icahn School of Medicine at Mount Sinai, describes her work on a team that improved the discharge process at Mount Sinai Medical Center  leading to a 73 percent increase in discharges before noon. If you're interested in leading your own quality improvement initiative, check out the IHI Open School Practicum  a guide to applying quality improvement in your own local project. (Note: This essay was originally submitted for the David Calkins Memorial Scholarship. To learn more, click here.)

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.

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