Discharge to Door

1. Discharge to Door Kaizen #3

2. Team • Nurse Practitioner: • Nurse: • Pharmacist: • Hospitalist: • Radiology: • Care Manager: • Social Worker: • Home Health: • Accounting: • PI Coach: • Patient: • Palliative Care:

3. Event Expectations • Document Current State Discharge Process • Develop a Future State Discharge Process • Capture “Before” Event Metrics • Create Discharge Audit Form & Team • Develop Action Item List • Develop Final Presentation

4. Current State Flow Chart

5. Current State Flow Chart Discharge Order Written Nurse Secretary discovers discharge order in chart First time anyone knows discharge is eminent

6. Major Blocks Clinical Housing, Meds, Transportation 1st 4 Hours Next 4 + Hours

7. Current State Flow Chart Discharge Order Social Worker Nurse Secret- ary Charge Nurse Care Manager & Pharmacy Care Partner Bedside Nurse

8. Current State Flow Chart Discharge Order Social Worker Nurse Secret- ary Charge Nurse Care Manager & Pharmacy Care Partner Bedside Nurse

9. Data Analysis • 59 Patients chosen at random from thousands • January patients chosen since their records would be complete • Measuring time from Doctor’s (discharge) order to time patient was checked out of system

10. 9.1 Hrs 8.4 Hrs 7.6 Hrs 6.3 Hrs 6.3 Hrs 5.0 Hrs 4.5 Hrs January 2010 Data

11. 53% 47% 1st 5 Hours Hours 6 - 33 January 2010 Data

12. Noon January 2010 Data

13. 30 Day Action Items

14. 30 Day Action Items (2)

15. Future State “Pending Discharge” Order (24 Hrs in Advance) Social Worker Care Manager Care Partner Clinical Dis- charge Nurse Secret- ary Charge Nurse Pharmacy Bedside Nurse

16. Event Outputs • Document Current State Discharge Process • Develop a Future State Discharge Process • Capture “Before” Event Metrics • Create Discharge Audit Form & Team • Develop Action Item List • Develop Final Presentation √ √ √ X √ √