Reducing Discharge Time on Patient Floors

1. NC STATE University Reducing Discharge Time on Patient Floors Marianne Jackson1, MD, Jillian Johnson1, Stacey Thompson2, RN, Sally John2, RN, Chad Letferis2, Lukasz Mazur1, PhD 1. Industrial Extension Service 2. Rex-UNC Healthcare North Carolina State University,Raleigh, NC 27695 Raleigh, NC . • Background • After orders for admission are written, patients are waiting hours and sometimes overnightin the ED, CTRU, ICU and PACU for transport to an inpatient bed. This leads to: • Productivity losses in surgery • Overtime for nurses • Diminished patient safety and satisfaction • A significant and common effect of delay is unavailability of a bed due to delayed discharges. • Although some delays are necessary for insurance and hospital procedure purposes, there are • still many preventable delays that affect the process. Some of these causes include: • Contingencies • Patients believed or had been told they could stay • Orders written at inconsistent times • Nurses not always being able to anticipate discharges Results The new discharge process increased the number of patients discharged before 11am from 39.5% to 25.8% despite an increase of discharge orders written after 9am. There was a decrease in the time it takes for a patient to leave after the physician has written the discharge order. In addition, patient satisfaction increased in areas of nurse preparation and communication. Conclusion and Implications With the success of the pilot a three month pilot of the same intervention was approved byleadership team for three inpatient floors. This pilot will show the longevity of our proposal and prove even further the need for a dedicated position of a discharge/administrative nurseon nursing floors. • References • 1. Mazur, L.M. and Chen, S.-J., “Understanding and Reducing Waste Due to Medication Errors via Systems Mapping and Analysis”, Health Care Management Science, vol. 11; pp. 55-65, 2008. • 2. Mazur, L.M.  and Chen, S.-J. “An Empirical Study for Medication Delivery Improvement Based on Healthcare Professionals’ Perceptions of Medication Delivery System,” Health Care Management Science, vol. 12; pp. 56-66, 2009. • 3. Mazur, L.M. and Chen, S-J., and Prescott, B. “Pragmatic Evaluating of Toyota Production System (TPS) Analysis Procedure for Problem Solving with Entry-Level Nurses,” Journal of Industrial Engineering and Management, December, vol. 1, no. 2; pp. 240-268, 2008. • 4. Sobek, D.K., and Jimmerson, C. “A3 Reports: Tool for Process Improvement, Paper Presented in the Industrial Engineering Research Conference, Houston, Texas, 2004. • 5. Spear, S.J. “Fixing Healthcare from the Inside, Today,” Harvard Business Review, vol. 83, no. 9; pp. 78-91, 2005. • 6. Spear, S.J., and Bowen, H.K. “Decoding the DNA of the Toyota Production System,” Harvard Business Review, vol. 77, no. 5; pp. 97-106, 1999. Purpose of the Study We hypothesize that by dedicating a position for a discharge/administrative nurse on the inpatient floors, we will be able to decrease the average length of a discharge. • Methods • We started with a focus group approach to analyze the current discharge process guided by • Toyota Production System (TPS) or ‘lean’ methodology for problem solving [1-6]. A group comprised of nurses and engineers observed the process and developed a chart of the current system [Figure 1]. Next, the group developed the ideal process [Figure 2] and proposed a pilot to test the changes. • The pilot study was approved by the leadership team for two days on two different inpatientunits. The major intervention included a discharge nurse that would focus morning hours to discharging medically ready patients. In the evening the discharge nurse would recognize patients that were potentially leaving the next day and prepare them for morning discharge. For example at night a discharge/administrative nurse would: • Have a conversation with the patient informing them about the likely discharge the next day • Finalize the necessary equipment, phone calls and discharge paperwork • Most importantly, the nurse would ask the patient if he/she could do anything to further help them with the discharge process