Improving Early Discharge Using a Team-Based Structure for Discharge Multidisciplinary Rounds

Patel, Hemali; Yirdaw, Essey; Yu, Amy; Slater, Lisa; Perica, Katharine; Pierce, Read; Amaro, Connie; Jones, Christine

doi:10.1097/ncm.0000000000000318

Cited by 39 publications

(42 citation statements)

References 15 publications

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“…In this study, our intervention was associated with a significant increase in DCBN comparing the preintervention to the postintervention periods. Previous studies have shown that increased DCBN through quality improvement efforts is an achievable goal 2,3,5,8 . Many of these initiatives have been conducted in medicine units, and this study represents one of the few studies specific to a surgical service.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that increased DCBN through quality improvement efforts is an achievable goal. 2,3,5,8 Many of these initiatives have been conducted in medicine units, and this study represents one of the few studies specific to a surgical service. We were able to increase our DCBN percentage from 8% to above 50%, reaching the goal for the first time in September 2016.…”

Section: Discussionmentioning

confidence: 99%

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Discharge by Noon: A Checklist Initiative by the Otolaryngology Service

et al. 2020

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Objectives/Hypothesis Hospital length of stay (LOS) and throughput are critical issues for hospitals. Late hospital discharges contribute to bottlenecks in the emergency department, overcrowd surgical and procedural areas, and limit patient tertiary‐care center transfers. Our goal was to increase discharge by noon (DCBN) percentage from 8% to over 50% in a sustainable manner. Study Design Retrospective Review. Methods We used a multiple time series design and a quality improvement approach. An interdisciplinary improvement team (IIT) identified the main causes contributing to late discharge and then developed and implemented multiple interventions to increase the percentage of DCBN. Admissions and discharge information were obtained for all patients in the otolaryngology service (January 2014–September 2017). The intervention was implemented in July 2015. The primary outcome was the percentage of DCBN per month. Secondary outcomes were LOS, case‐mix index (CMI), patient experience, and 30‐day readmissions. We analyzed the impact of our intervention and outcomes at the preintervention, peri‐intervention, and postintervention periods. Results One thousand four hundred sixty‐four admissions to the otolaryngology service were included. Throughout the intervention period, the percentage of patients DCBN increased. Analysis of the intervention showed significant DCBN change of 15% in the first versus 42% in the last 12‐months (P < .001), and shorter LOS (−1.4 days, P < .001) and lower CMI (−0.6, P < .001) in the DCBN group. Patient satisfaction scores improved by 4% (P < .05), and no difference in 30‐day readmission rates (P = .29) was shown. Conclusions This multifaceted intervention improved early discharge and patient experience. Our checklist of key behaviors could be applied throughout other services and hospitals with reproducible success. Level of Evidence 4 Laryngoscope, 131:E76–E82, 2021

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Discharge by Noon: A Checklist Initiative by the Otolaryngology Service

et al. 2020

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“…Communication across care teams and improved interdisciplinary care has been recognized as an important factor for high-quality patient-centered care and for high-functioning teams. Studies have shown that when care teams communicate better, efficiency outcomes are improved [ 18 ]. Patients have also expressed a need for the clinical staff caring for them to communicate with each other more effectively [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach

Keniston¹,

McBeth²,

Pell³

et al. 2021

JMIR Hum Factors

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Background Typical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams. Objective Applying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings. Methods We employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys. Results We conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness. Conclusions Survey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool.

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“…14 Numerous specific interventions to manage capacity strain and optimize patient flow have been described in the literature, including strategies that focus on earlier discharges, huddles, and reducing unnecessary hospital days. [17][18][19][20][21] It is clear that hospital flow is of strategic importance to many hospital systems; however, the perceived impact of the various strategies has not been well studied.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Hospital Capacity Strain: a Qualitative Analysis of Experience and Solutions at 13 Academic Medical Centers

Arogyaswamy¹,

Vukovic

Keniston

et al. 2021

J GEN INTERN MED

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Background Hospital capacity strain impacts quality of care and hospital throughput and may also impact the well being of clinical staff and teams as well as their ability to do their job. Institutions have implemented a wide array of tactics to help manage hospital capacity strain with variable success. Objective Through qualitative interviews, our study explored interventions used to address hospital capacity strain and the perceived impact of these interventions, as well as how hospital capacity strain impacts patients, the workforce, and other institutional priorities. Design, Setting, and Participants Qualitative study utilizing semi-structured interviews at 13 large urban academic medical centers across the USA from June 21, 2019, to August 22, 2019 (pre-COVID-19). Interviews were recorded, professionally transcribed verbatim, coded, and then analyzed using a mixed inductive and deductive method at the semantic level. Main Outcome Measures Themes and subthemes of semi-structured interviews were identified. Results Twenty-nine hospitalist leaders and hospital leaders were interviewed. Across the 13 sites, a multitude of provider, care team, and institutional tactics were implemented with perceived variable success. While there was some agreement between hospitalist leaders and hospital leaders, there was also some disagreement about the perceived successes of the various tactics deployed. We found three main themes: (1) hospital capacity strain is complex and difficult to predict, (2) the interventions that were perceived to have worked the best when facing strain were to ensure appropriate resources; however, less costly solutions were often deployed and this may lead to unanticipated negative consequences, and (3) hospital capacity strain and the tactics deployed may negatively impact the workforce and can lead to conflict. Conclusions While institutions have employed many different tactics to manage hospital capacity strain and see this as a priority, tactics seen as having the highest yield are often not the first employed. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07106-8.

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Improving Early Discharge Using a Team-Based Structure for Discharge Multidisciplinary Rounds

Cited by 39 publications

References 15 publications

Discharge by Noon: A Checklist Initiative by the Otolaryngology Service

Discharge by Noon: A Checklist Initiative by the Otolaryngology Service

Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach

The Impact of Hospital Capacity Strain: a Qualitative Analysis of Experience and Solutions at 13 Academic Medical Centers

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