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
1. Document Current State Discharge Process
2. Develop a Future State Discharge Process
3. Capture “Before” Event Metrics
4. Create Discharge Audit Form & Team
5. Develop Action Item List
6. Develop Final Presentation
4
Current State Flow Chart
5
Current State Flow ChartDischargeOrder
Written Nurse Secretary discovers discharge order in chartFirst time anyone knows discharge is eminent
6
Major BlocksClinical Housing, Meds, Transportation
1st 4 Hours Next 4 + Hours
7
Current State Flow Chart
Care Manager & Pharmacy
Social Worker
Bedside Nurse
DischargeOrder
NurseSecret-
ary
ChargeNurse
Care Partner
8
Current State Flow Chart
Care Manager & Pharmacy
Social Worker
Bedside Nurse
DischargeOrder
NurseSecret-
ary
ChargeNurse
Care Partner
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
January 2010 Data
Average Discharge Time by Unit
548505
458
378 369
297268
0
100
200
300
400
500
600
Unit
Un
it A
ve
rag
e in
Min
ute
s
Unit Average 548 505 458 378 369 297 268
4W 2W 2E 6W 6E 5W 5E
9.1 Hrs 8.4 Hrs 7.6 Hrs 6.3 Hrs 6.3 Hrs 5.0 Hrs 4.5 Hrs
11
Time to Discharge
26%21%
15% 15%
6% 6% 4% 6%
0%0%5%
10%15%20%25%30%
Minutes
% o
f Dis
char
ges
January 2010 Data
47% 53%
1st 5 Hours Hours 6 - 33
12
Discharges by Time of Day
1
5
13
3
13
6
7
2
5
2
0
1
00
2
4
6
8
10
12
14
Befor
e Noo
n
Noon -
1300
1301
- 14
00
1401
- 15
00
1500
- 16
00
1601
- 17
00
1701
- 18
00
1801
- 19
00
1901
- 20
00
2001
- 21
00
2101
- 22
00
2201
- 23
00
2301
- 24
00
Time of Day
Nu
mb
er o
f D
isch
arg
es
January 2010 Data
Noon
13
30 Day Action Items
Item Action Owner Due
1 Flag D/C patient’s charts & review immediately after STAT charts
Julie
2 Develop standardized D/C process for use hospital-wide
Robert
3 Process all ancillary orders as STAT
Debra
4 Scan D/C Med orders STAT Shelly
5 Develop & Beta test “white board”
Stephanie
6 Case Manager & Social Workers begin preparing multiple placement options
Darlene
14
30 Day Action Items (2)
Item Action Owner Due
7 Develop & use D/C checklist for all disciplines
Robert
8 Print In-Patient Med labels for use post discharge (avoid re-labeling)
Shelly
15
Future State“Pending Discharge”
Order (24 Hrs inAdvance)
Social Worker
Bedside Nurse
NurseSecret-
ary
ChargeNurse
Care PartnerClinical
Dis-charge
Care Manager
Pharmacy
16
Event Outputs
√
√
√
√
√
X
• 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