Improving Hospital Discharge Time

Abstract

Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions.The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process.This is a quantitative pre and post-intervention study.Three hundred and eighty-six bed tertiary care hospital.A series of Six Sigma driven interventions over a 10-month period.The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients.Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P < 0.001). A greater proportion of patients left their room before noon in the postintervention period (P < 0.001), though there was no statistical difference in before noon discharge. Hospital LOS dropped from 3.4 to 3.1 days postintervention (P < 0.001). ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 ± 7.8 vs 5.9 ± 7.7 hours; P < 0.001).Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.

Improving Emergency Department radiology transportation time: a successful implementation of lean methodology

“…Much of the focus on improving ED throughput has been on addressing the ED boarder problem and inpatient bed availability; ED boarders are patients who end up waiting in the ED after a decision to admit has been made because of lack of inpatient beds. Although ED boarding is a serious problem with established safety concerns and one that places a heavy burden on ED resources, the solution is often tied to inpatient bed availability and hospital throughput, both of which involve many stakeholders well beyond the ED [ 7 – 10 ]. Designing processes to reduce turnaround time of ED studies can help improve ED flow, especially for low acuity patients, −many of whom require radiographic imaging and end up being discharged from the ED and are therefore not part of the inpatient bed bottleneck.…”

What Can Emergency Medicine Learn From Kinetics

“…The typical measurements which have been endorsed by the regulatory bodies can detect the variations of the ED performance in certain levels. 2 , 4 , 6 , 10 However, this presents results for the ED performance in essential variation managements individually and retrospectively, 4 while the time efficiency issue is rarely discussed. A solution to this problem is to utilize a kinetic analysis, which will result in creating a criterion standard in order to provide a reliable estimation to ED providers, implementation plan designers, medical auditors, and health insurance payers.…”

Correlation of Admision Time, Discharge Time and Patients Discharge Type With Length of Stay in Yellow Zone of Emergency Department

“…By knowing the transfer time of patient from the ED into the inpatient unit at certain hours would indicate that at that time usually patients in the inpatient unit discharged (El-Eid et al, 2015). Most of the transfer time of patients was at 0 am to 12 am, the result was in contrast to a study that explained that patients who were discharged before 12 pm would increase the number of empty beds in the inpatient unit and patients in the ED could soon be transferred, patients in the inpatient unit were discharged before 12 pm would increase the celerity of patients discharge time from the ED and would soon be transferred at 3 pm to 8:00 pm (Rabin et al, 2012;Wertheimer et al, 2015).…”