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Learning Objective 1: Define physiologic discharge criteria.
Learning Objective 2: Define a model for reducing waste at discharge.
Patient flow, bed turnover and patient placement remains a challenge for inpatient nursing units as the complexity and volume continues to increase. Strategies focused on clinically appropriate placement and increased physical capacity are often mired by challenges associated with discharging patients in a timely and efficient manner.
Aim
A physician and nurse led team including bedside nurses, nursing managers, physicians, quality improvement specialists and a data analyst was formed to identify and address the opportunities for relieving pressure on the system through increased efficiency in discharging patients. The goal for the team was to increase the percentage of Hospital Medicine patients who have met physiologically ready criteria who will be discharged within two hours of reaching that goal on three inpatient medical units.
Results
Through the use of quality improvement methodology, the team was able to make modifications to the system that resulted in processes affecting patient discharge that relieved the pressure at the time of discharge enabling patients to go home when they are physiologically ready and eliminating waste in the system without compromising care. Collaborative efforts were carried out with multiple services of the organization including information technology, pharmacy, nursing and medical training services.
Conclusion
Through collaborative work, guided by quality improvement methods, the team was able to improve the timeliness of discharges for patients meeting their physiologic discharge criteria without impacting the quality of care delivered as measured by readmission rates. The care delivery teams began to think differently about reducing waste by being more methodical in their planning and decision making. The success of the work has been spread to surgical services for parallel learning with the ultimate goal that every patient and family will be discharged when they are physiologically ready and will not be delayed by care delivery system.