Improving Discharge Timeliness

Purpose:
The % of patients discharged before 11am in general pediatrics has ranged between 8 and 15%, reflecting a poorly designed system. The Discharge Timeliness PI Team has been able to demonstrate sustained improvement so that 23% discharged before 11am for 2012, resulting in improved throughput.

Significance:
The ability of a hospital to safely and efficiently discharge a patient in a timely process requires a coordinated effort. A highly reliable throughput process clearly has many potential benefits to multiple stakeholders including the patient/family, providers, hospital, and payers.

Strategy and Implementation:
A PI team came together consisting of physicians, case managers, and nursing leadership to create a “Discharge Timeliness Bundle." Using a rapid cycle improvement methodology, the PI team implemented multiple cycles of improvement using standard PDCA cycles.Cycle #1- Create Current Process to Implement New Process Flow– key “Change Concepts” included (1)7:30 am Team Lead-Hospitalist Huddle;(2)8 am rounds with RN and MD; (3) by Noon– MD and Case Management Huddle;(4) By 4pm– Next Day's Discharges Identified.Cycle #2-Implemented a “audit” tool completed by each Unit to identify how well each element of change concept was consistently followed.Cycle #3- Implemented a “audit” tool completed by each Unit to identify how well each element of change concept was consistently followed. Results regarding discharge timeliness shared via scorecard,staff meetings, quality/ safety meetings.

Evaluation:
Success was measured by tracking % of patients discharged before 11am from 2010 through 2012. On the 4th floor, from a low of 14% and a high over 30% with 2012 mean over 20% discharge rate before 11am. On the 5th floor with a low of 8% discharge to a high of over 28% with a mean over 20% in 2012.

Implications for Practice:
The use of a discharge bundle supports improving care coordination as well as throughput. Key components of the bundle that are of key importance involve unit based physicians and RN/MD bedside rounding. This has enabled a clear plan pertaining to discharge to be articulated and adhered to.