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

Abstract

Background: Delays in hospital discharge occur when patients are medically cleared but continue to remain hospitalized. Discharge delays can result in reduced levels of treatment, placing patients at risk of functional decline, falls and hospital-related adverse events. The Institute of Medicine has highlighted timely, efficient, and safe hospital discharge as a marker for quality care. Hospitals, however, are often unable to meet discharge targets. Research has shown improvements in discharge planning through system-level approaches that integrate health care and social work. The purpose of this study is to describe the development and implementation of a multidisciplinary team intervention to overcome discharge barriers for patients with prolonged hospitalization. We also evaluated the impact of the intervention on length of stay, readmission rates and care team satisfaction and morale. Methods: A multidisciplinary discharge coordination team met weekly to proactively raise and resolve patient-related discharge issues for all patients admitted to the general medicine wards. Members included hospitalists, case managers, social workers, hospital finance representatives, and patient representatives. One of the hospital physicians facilitated the meetings. Results: Barriers to discharge included patient and family reluctance to discharge, medical delays in performing diagnostic tests or procedures, long-term care facility acceptance delays, and prolonged wait times for insurance approvals. Our multipronged approach decreased length of stay in our delayed discharge patient population from 15.45 days to 9.04 days, a 41.5% reduction, without an increase in readmissions. The healthcare team perceived the weekly multidisciplinary team meetings quite positively; 90% of respondents agreed that the meetings improved communication and increased their sense of support. Conclusion: Our intervention was successful in improving hospital processes to overcome barriers to patient discharge. We believe that similar multidisciplinary meetings can be implemented in hospitals throughout the region to decrease risks of prolonged hospitalization and, ultimately, improve hospital efficiency and care delivery.

Evaluating the Hospital Standardized Home-Transition Ratios for Cerebral Infarction in Japan: A Retrospective Observational Study from 2016 through 2020

“…As for future studies, it will be necessary to consider the characteristics and discharge support systems applied by good HSHR hospitals so that poor HSHR hospitals can benefit from improving the home-transition rate [ 33 , 34 ]. To improve the quality of hospital care, it is important for hospitals to check the quality of their care management, including discharge management.…”

Development of an acute medical unit to optimize patient flow and early discharges in a tertiary care hospital in the United Arab Emirates

“…This trend is consistent with changes in hospitalization patterns for patients with non-COVID-19 diagnoses during and after the COVID-19 pandemic [ 35 ]. Finally, other interventions addressing patients with a prolonged LOS were conducted during the same time as the introduction of the AMU [ 34 ]. However, these interventions focused on complex discharge planning in patients with prolonged hospitalization and did not address early discharges from the AMU.…”

“…The problem of delayed discharges and increasing LOS is a system-level issue and requires a whole-system approach [32,33]. Best practices to address discharge delays target practice changes and information sharing [20,34]. The implementation of the AMU involved both an organizational change by restructuring the internal medicine service to improve patient flow and enhance the system's efficiency, as well as improved departmental communication to facilitate information sharing and frequent opportunities for interprofessional collaboration.…”

Length of stay in the clinical wards in a hospital after introducing a multiprofessional discharge team: An effectiveness improvement report

“…Therefore, reducing hospital LOS enhances the patient experience and promotes the sustainability and effectiveness of the healthcare system. 3 The reasons for hospital overcrowding are many and complex, but the increasing demand and lack of inpatient ward beds are essential factors. 4,5 As the physical expansion of wards has limitations, hospital administrative leaders are constantly looking for opportunities to improve the efficiency of bed use.…”

“…This resource optimization can also help alleviate healthcare system pressures during periods of high demand, such as public health crises or disease outbreaks. Therefore, reducing hospital LOS enhances the patient experience and promotes the sustainability and effectiveness of the healthcare system 3 …”