Optimizing the patient discharge process

After an inpatient hospital stay, many individuals are eager to get home as soon as possible, but the process for discharge is no easy feat.

It’s multifaceted and requires all members of the patient care team to be involved. For example, nurses spend time with patients to provide education on staying well and review discharge instructions and medication. Care managers arrange patient transportation and address any last-minute patient needs.

It can be a time-consuming process.

“The earlier in the day patients are discharged from the hospital, the more time they have to get necessities, such as prescriptions or medical equipment to continue their care from home,” said Sadie Paige, Performance Improvement (PI) specialist for the Eastern Region. “Discharging patients earlier in the day also allows us to decrease the wait time for new admissions coming from the emergency department and direct admits from physician offices.”

OSF HealthCare Sacred Heart Medical Center in Danville partnered with Performance Improvement to optimize this process.

Getting ahead of daily discharges

In line with OSF HealthCare strategy, OSF Sacred Heart and PI specialists had a lofty goal: to successfully discharge 25% of patients by 11 a.m. every day.

“At the very beginning of this project, we were averaging between 7-8% of patients getting discharged by 11 a.m.,” said Kim Smith, a social work case manager at OSF Sacred Heart. “I looked at our PI specialist like she had three eyes. I thought this goal nearly impossible.”

Within a couple of months, Mission Partners from multiple departments within OSF Sacred Heart and PI had a plan in place to begin discharging patients earlier. At the beginning, members of the care team would have an in-person huddle every day at 1:30 p.m. to identify individuals who could leave by 11 a.m. the next day.

Now doctors, respiratory therapists, charge nurses and other team members are having these discussions through a platform within the electronic medical record the day before discharge. Doctors are also expected to enter their discharge orders in the electronic medical record by 9 a.m. on the day the patient will go home.

“Starting discharge planning discussions sooner was a big factor in helping us achieve our goal,” said David Ibrahim, MD, lead hospitalist at OSF Sacred Heart. “Everyone is on the same page and is aware of what needs to be done the day before a patient is discharged. We’re not waiting to have these conversations the day of.”

Two months in

It’s only been two months, but the work OSF Sacred Heart and PI have done is already producing positive results.

“We kicked this project off on May 4,” Sadie said. “Since then, we have increased the number of people discharged by 11 a.m. from 7-8% to 18-20%. We’ve also seen reductions in our patient’s length of stay in the emergency department.”  

This means patients are having discussions with their care team about the discharge process sooner. They are getting their prescriptions and recovery education sooner. And they are getting home in a timely manner.

“We have seen many benefits for our patients and have improved the flow of people through the hospital with the implementation of this project,” said Danielle Molina, DNP, RN, director of Professional Practice at OSF Sacred Heart. “This success was achieved with great team collaboration, open-mindedness and feedback.”

If the project continues to see positive results, it could be spread to the rest of the Eastern Region, covering Champaign, Bloomington and Pontiac.

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