Improving Time to Discharge for Patients Going Home

Patient flow in hospitals is a multidisciplinary, complex process. Efficient flow of patients is important as hospitals struggle with decreasing revenue and increasing capacity. Patient throughput, particularly timely patient discharges, is an on-going challenge for many organizations. Hospital leadership must set the importance of patient flow with all clinical and non-clinical members of the patient care team. Specific, measureable and attainable goals are an important first step. The ability to collect meaningful data is crucial to achieving targets and tracking progress. Identifying and addressing barriers identified by the team is a required leadership task.

ED overcrowding is a systemic issue in healthcare. Patients boarded in the ED are known to have decreased satisfaction and poorer outcomes than patients who do not have to wait for a bed. By maximizing timely discharges in the morning, boarded or “hold” hours can be reduced and quality and satisfaction of care can be increased. Placing an emphasis on the patients waiting in the Emergency Department and requiring inpatient nursing directors to perform nurse leader rounding on them, the directors have  an appreciation and impetus to work with their teams to discharge patients who are ready to go before 1300.

Our hospital Division has a robust data collection process for tracking patient flow. We developed an integrated team to address the issue of low percentage of patients being discharged by 1300. Each nursing unit has implemented a short cycle process improvement tactic to increase the number of patients with discharge orders being discharged from the hospital by 1300. We have seen our percentage increase from 27% to 31% in the first month. Hardwiring the behavior changes for nursing staff, developing hand-off reports and planning for day of discharge needs have been a few tactics implemented. Emphasizing the “why” and importance to the quality of care being delivered to all of our patients will ensure our success to reach our goal of discharging 50% of our patients in the timeframe.