Discharge Criteria Decrease Variability and Improve Efficiency

Abstract

BACKGROUND AND OBJECTIVES: To determine the effect of discharge criteria on discharge readiness and length of stay (LOS). Discharge inefficiency is a common barrier to hospital flow, affecting admissions, discharges, cost, patient satisfaction, and quality of care. Our center identified increasing discharge efficiency as a method to improve flow and better meet the needs of our patients. METHODS: A multidisciplinary team was assembled to examine discharge efficiency and flow. Discharge criteria were created for the 3 most common diagnoses on the hospital medicine service then expanded to 10 diagnoses 4 months into the project. Discharge workflow was evaluated through swim lane mapping, and barriers were evaluated through fishbone diagrams and a key driver diagram. Progress was assessed every 2 weeks through statistical process control charts. Additional interventions included provider education, daily review of criteria, and autotext added to daily notes. Our primary aim was to increase the percentage of patients discharged within 3 hours of meeting discharge criteria from 44% to 75% within 12 months of project implementation. RESULTS: Discharge within 3 hours as well as 2 hours of meeting criteria improved significantly, from 44% to 87% and from 33% to 78%, respectively. LOS for the 10 diagnoses decreased from 2.89 to 1.47 days, with greatest gains seen for patients with asthma, pneumonia, and bronchiolitis without a change in the 30-day readmission rate. CONCLUSIONS: Discharge criteria for common diagnoses may be an effective way to decrease variability and improve LOS for hospitalized children.

Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges

“…Hospitals have trialed several different initiatives to improve the efficiency of patient discharges, including implementation of discharge criteria for common diagnoses, use of communication boards, and computer applications to facilitate the discharge process, all with varying levels of success. 11,12 Mathews et al, for instance, describe an electronic medical record prompt that identified the likelihood of a patient's next day discharge as red (unlikely), yellow (possible), or green (likely). 11 Although the tool helped to facilitate discharges, it was reliant on the physicians to accurately predict and facilitate hospital discharges.…”

Discharge criteria for inpatient paediatric asthma: a narrative systematic review

“…Due to individual centres using different ICPs, this study did not specify individual discharge criteria. One study did not list participant numbers 16…”

Duration of monitoring after cessation of oxygen therapy in infants with bronchiolitis

“…Similar to Shadman et al and Sheft et al, we were able to demonstrate that protocol implementation resulted in improved adherence to clinical recommendations for children with bronchiolitis and resulted in shorter length of stay. 18,19 According to Scheft et al, strategies including the creation of specific discharge criteria within institutions as well as embedding the discharge criteria into daily notes can aid in improving adherence to protocols and recommendations. These strategies can empower physicians to discharge earlier when discharge is safe and appropriate.…”

“…These strategies can empower physicians to discharge earlier when discharge is safe and appropriate. 19 In addition, studies are required to evaluate whether nursing-led discharge would result in a change in culture around discharge planning in addition to stricter adherence to policy recommendations with a corresponding reduction in length of stay. These measures are important to consider, as timely discharges are beneficial to health-care systems by improving financial and resource efficiency and allowing more efficient bed turnover.…”