Discharge Timeliness for Mother Baby Couplets: A Six Sigma Project to Improve Throughput

Purpose:
A need was identified to improve the transition of care at discharge to home for new mothers and babies. The goal was to improve the throughput and timeliness of mother baby couplet discharges by 1200 from 30% to 80%

Significance:
The delays compromised patient safety, stakeholder satisfaction, and facility revenues. Admissions to Labor and Devilery and the transfers of delivered patients were delayed due to the timeliness of discharges. The health and well-being of laboring mothers and their infants was at risk.

Strategy and Implementation:
Multiple process changes were implemented. Physicians were engaged in the process to complete earlier discharges. Charge nurses received education regarding their roles in the throughput process and were given a reduced assignment. A workflow in the electronic documentation system was developed to streamline the communication of written discharge orders for the primary nurse. A list of expected discharges was developed each evening to prompt the evening shift nurses to discuss discharge plans with the patient and secure transportation by 1200. A patient self assessment tool and discharge appointment process was implemented to enhance patient education. An automated process for lactation consultation was developed through changes in clinical documentation screens and the nursing careplan, allowing patients to receive breastfeeding assistance more quickly. Bili-blanket equipment was made available on the unit for babies requiring home treatment for hyperbilrubinemia.

Evaluation:
95% of the obstetric and pediatric practitioners discharged by 1200. Charge nurses effectiveness improved. A tool was used to score their improved performance. Improved patient Discharge preparation, more timely access to service and needed equipment, improved from 30% by 1200 to 80%.

Implications for Practice:
The implementation of the processes promoted an individualized and organized method for mother/baby couplet discharges. Conflict and dissatisfaction among stakeholders declined. Admissions and discharges were expedited. Quality of care was improved for laboring patients needing care upon arrival.