Using the DMAIC Process to Improve Discharge Process and Readmission Rates

Purpose:
Developed a position to increase communication directly impacting discharge times while increasing patient satisfaction as evidenced by HCAHP scores and data resulting from a Lean Six Sigma project.

Relevance/Significance:
Communication remains one of the biggest barriers in the healthcare setting. Evidence repeatedly shows that a decrease in communication leads to errors and poor patient outcomes. A method of increasing communication to directly impact discharge times and patient satisfaction with the discharge process was needed.

Strategy and Implementation:
Discharges per day were retrospectively measured for 300 discharges. Data determined that our 7 primary services (Urology, Surgical Oncology, Vascular Surgery, Bariatric Surgery, General Surgery, Plastic Surgery, and Microsurgery) discharged their patients on Mondays, Wednesdays, Thursdays, Fridays and Saturdays between 9 am and 5 pm. A discharge RN was created and assigned to work these days during a two month pilot. Led by unit leadership and supported by the entire staff. The discharge RN was the leader of the discharge process rounding on patients, completing discharges, gathering necessary equipment and supplies for discharge, ensuring discharge education was completed and providing the patient safe transportation to the discharge area either personally or via the resources available. This individual was not intended to replace the Care Coordinator but to enhance the bedside RN's opportunities to move patients through the system in a more efficient manner.

Evaluation:
Readmission Rate down from 15% in Dec. 2014 to 13% in Jan. 2015. D/C's by noon up to 20% in Mar. 2015 from 15% in Jan. and Feb. 2015. Length of Stay down to 6.1 in Mar. 2015 from 8.3 in Feb. 2015 HCAHPs: How would you rate the efficiency of the DISCHARGE process improved Dec. 2014, 62.1 to 89.9 in Jan. 15 and 91.7 in Feb. 15 Ave. D/C time was 14:27 hrs during pilot down from 16:04 hrs prior.

Implications for Practice:
Two month trial completed without increasing personnel costs. Decreased time of discharge by 3 to 3 and ½ hours each day. Increased HCAHP scores addressing discharge process. This role can be filled by the Clinical Coordinator moving forward reestablishing role in the capacity throughput process.