Focusing on the Medically Ready for Discharge Patient Using a Reliable Design Strategy: A Quality Improvement Project to Improve Length of Stay on a Medicine Service

Abstract

Background and Objectives: Length of stay is a common measure of efficiency of care. We aimed to reduce length of stay on a general medicine service through a structured quality improvement project. Methods: A reliable design strategy was implemented in successive stages at a 238-bed academically-affiliated VA hospital. Over a 2-year period, continuous improvement efforts were directed at discrete cohorts of patients deemed medically appropriate for discharge but who remained hospitalized because of discharge barriers. We compared the mean length of stay and medically-ready bed days of care for a hospital in statistical control charts. Pre-and post-intervention comparisons were made using t-tests. Results: In total, 5321 discharges were included in this improvement project, accounting for 35 852 bed days of care. Overall, average length of stay was reduced by 15.7%, from 7.62 to 6.40 days (P < .05). There was a significant reduction in the mean number of medically-ready bed days of care from 2.3 to 1.72. Statistical process control charts demonstrated special cause variation across patient cohorts. Conclusion: A quality improvement project using reliable design principles was associated with shorter length of stay.

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

“…The team reviewed discharge barriers and developed individualized care plans. 16 In this case report, we describe the development and implementation of a multidisciplinary team intervention to overcome discharge barriers for patients with prolonged hospitalization. We evaluate the impact of the intervention on length of stay, readmission rates, and care team satisfaction and morale.…”

Medically ready for discharge: A multisite “point‐in‐time” assessment of hospitalized patients

“…11 Whereas administrative utilization review tools to assess "appropriateness" of hospital days have been criticized for their retrospective approach and low level of validity when compared to expert review, 12,13 use of a clinician-driven "medically ready for discharge" determination provides an opportunity for real-time, meaningful decision-making that can be incorporated into daily operational and quality improvement activities. [14][15][16] In addition, deploying this type of approach across different hospitals can provide important insights into broader issues. For example, in the current health care environment, hospital capacity strain is an urgent and critical priority.…”

“…The point at which a patient becomes “medically ready for discharge” (acute hospital‐level needs have resolved, and the patient is clinically considered an appropriate candidate to move to a lower level of care) is an important marker within total LOS and can be used to distinguish delays in progression of care from discharge barriers 11 . Whereas administrative utilization review tools to assess “appropriateness” of hospital days have been criticized for their retrospective approach and low level of validity when compared to expert review, 12,13 use of a clinician‐driven “medically ready for discharge” determination provides an opportunity for real‐time, meaningful decision‐making that can be incorporated into daily operational and quality improvement activities 14–16 . In addition, deploying this type of approach across different hospitals can provide important insights into broader issues.…”