Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Ortiga, Berta; Salazar, Albert; Jovell, Albert J.; Escarrabill, Joan; Marca, Guillem; Corbella, Xavier

doi:10.1186/1472-6963-12-180

Cited by 38 publications

(34 citation statements)

References 10 publications

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“…In addition, the discharge day of SSU-patients was planned together with the admission day and also entered in the electronic information system. These working dynamics positively contributed to the standardization of the admission and discharge processes, explained in a previous paper [8] . The standardization of the discharge process was based on two main concepts: Firstly, the need for planning the activity and secondly, the promotion of a team incorporating different professional groups all working in the hospital.…”

Section: Resultsmentioning

confidence: 66%

Effectiveness of a new short-stay unit for elective low complexity patients’ admissions to improve patient flow

Ortiga

Bartolomé

Acebes

et al. 2013

JHA

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Background/Objective: Specialized care in an acute hospital is the highest resource consuming type of health care. Performance improvement in health care should look for a better application of medical knowledge and resource consuming at the same time as managers locally redesigned processes and organizations in order to be more cost-effective at healthcare services delivery. The aim of this study was to demonstrate the effectiveness of creating a short-stay unit for elective patients as an alternative to the elective patients being admitted in an acute ward. Methods:We included all elective patients admitted in a university hospital between the 1st of January and the 31st of December 2007, as well as those admitted during the same period of 2009, after two hospital wards transformation into a short-stay unit. We used the Hospital General Database for collecting information on years 2007 and 2009. Main key performance indicators were length of stay, pre-surgery length of stay, rotation rate, discharge planning rate and cost. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a T-test and a Wilcoxon signed ranks test and a Mann-Whitney test for non-normal continuous variables. Significance at p < .05 was assumed throughout. Results Conclusions:In conclusion, this approach to hospital bed management in a tertiary hospital has proven both possible and efficient. The creation of short-stay units for elective patient admissions allowed an increase in productivity per hospital bed due to a higher rotation rate and a reduction in human resources costs due to closing hospital wards at weekends.

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Section: Resultsmentioning

confidence: 66%

Effectiveness of a new short-stay unit for elective low complexity patients’ admissions to improve patient flow

Ortiga

Bartolomé

Acebes

et al. 2013

JHA

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“…36 Electronic-based communication about discharge has been described, such as the “Patient Tracker,” a computer-based application that Maloney et al used to standardize the discharge process. 22 Also, interventions similar to our use of the RYG Discharge Tool, which also deployed color alerts of red, yellow, and green, have been used to streamline treatment and discharge in hospitals.…”

Section: Discussionmentioning

confidence: 99%

Using the Red/Yellow/Green Discharge Tool to Improve the Timeliness of Hospital Discharges

Mathews

Corso

Bacon

et al. 2014

The Joint Commission Journal on Quality and Patient Safety

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Background As part of Yale-New Haven Hospital (Connecticut)’s Safe Patient Flow Initiative, the physician leadership developed the Red/Yellow/Green (RYG) Discharge Tool, an electronic medical record–based prompt to identify likelihood of patients’ next-day discharge: green (very likely), yellow (possibly), and red (unlikely). The tool’s purpose was to enhance communication with nursing/care coordination and trigger earlier discharge steps for patients identified as “green” or “yellow”. Methods Data on discharge assignments, discharge dates/times, and team designation were collected for all adult medicine patients discharged from October – December 2009 (Study Period 1) and October – December 2011 (Study Period 2), between which the tool’s placement changed from the sign-out note to the daily progress note. Results In Study Period 1, 75.9% of the patients had discharge assignments, compared with 90.8% in Period 2 (p < .001). The overall 11 A.M. discharge rate improved from 10.4% to 21.2% from 2007 to 2011. “Green” patients were more likely to be discharged before 11 A.M. than “yellow” or “red” patients (p < .001). Patients with RYG assignments discharged by 11 A.M. had a lower length of stay than those without assignments and did not have an associated increased risk of readmission. Discharge prediction accuracy worsened after the change in placement, decreasing from 75.1% to 59.1% for “green” patients (p < .001), and from 34.5% to 29.2% (p < .001) for “yellow” patients. In both periods, hospitalists were more accurate than housestaff in discharge predictions, suggesting that education and/or experience may contribute to discharge assignment. Conclusions The RYG Discharge Tool helped facilitate earlier discharges, but accuracy depends on placement in daily work flow and experience.

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“…Standardizing the admission process to a greater extent could for example benefit hospitals, as can be seen in Ortiga et al [22] Ensuring that the process is as easy and comprehensive as possible could benefit the studied hospitals and help them reduce the number of boarders and their average boarding time.…”

Section: Admission Processmentioning

confidence: 99%

Emergency boarding: An integrative framework for analyzing causes and seeking solutions

Limoges

Gemmel

Landry

et al. 2017

JHA

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Background: One of the root causes of crowding at the Emergency Department (ED) is boarding, i.e. the practice of holding admitted patients in the ED until an inpatient (IP) bed becomes available. Although ED boarding has been approached by various authors, few of them have aimed to see how different hospitals perform in regard to this issue. Objective: This study will approach ED boarding from different angles, analyzing both quantitative and qualitative data, and following both deductive and inductive reasoning. The purpose is to develop a validated integrative conceptual framework which can be used to analyze ED boarding, and to look for solutions. Methods: The development of the framework is based on an extensive literature review and a multiple case study research with both qualitative and quantitative data collection. Results: ED boarding was found to be prominent in the studied hospitals. Four root causes of ED boarding were elucidated, which are: (1) uncoordinated admissions and discharges, (2) late discharges, (3) the inability to discharge patients, and (4) a lack of communication, collaboration, and information between the different actors of the patient care process. Many solutions are proposed to improve these issues. Conclusions: Through the analysis of various types of data, an integrative conceptual framework for ED boarding was elaborated for analyzing causes and seeking solutions. The quantative data cannot only be used in the analysis stage, but can also help in designing a solution as there are clear recognizable trends in arrival, discharge and ED boarding time. "Communication, collaboration and information", although not explicitly discussed in the literature, was found to be the most prominent cause and solution to ED boarding in the field study. Practice implications: Management practitioners now have a framework demonstrating probable causes for ED boarding, which provides a starting point for analysis within their establishments. Pathways to improvement are suggested as well, which will help managers to reduce ED boarding. Communication, collaboration and information are important in these improvement efforts.

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Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Cited by 38 publications

References 10 publications

Effectiveness of a new short-stay unit for elective low complexity patients’ admissions to improve patient flow

Effectiveness of a new short-stay unit for elective low complexity patients’ admissions to improve patient flow

Using the Red/Yellow/Green Discharge Tool to Improve the Timeliness of Hospital Discharges

Emergency boarding: An integrative framework for analyzing causes and seeking solutions

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