Systematic identification and management of barriers to vascular surgery patient discharge time of day

Abstract

Objectives Length of stay fails to completely capture the clinical and economic effects of patient progression through the phases of inpatient care, such as admission, room placement, procedures, and discharge. Delayed hospital throughput has been linked to increased time spent in the emergency department and post-anesthesia care unit, delayed time to treatment, increased inhospital mortality, decreased patient satisfaction, and lost hospital revenue. We identified barriers to vascular surgery inpatient care progression and instituted defined measures to positively impact standardized metrics. Methods The study was divided into three periods: pre-intervention, “wash-in”, and post-intervention. During the pre-intervention phase, barriers to patient flow were quantified by an interdisciplinary team. Suboptimal provider communication emerged as the key barrier. An enhanced communication intervention consisting of face-to-face and mobile application-based education on key patient flow metrics, explicit discussion of individual patient barriers to progression at rounds and interdisciplinary huddles, and communication of projected discharge and potential barriers via e-mail was developed with input from all stakeholders. Following a four-week wash-in implementation phase, data collection was repeated. Results The pre- and post-intervention patient cohorts accounted for 244.3 and 238.1 inpatient days, respectively. Both groups had similar baseline demographic, clinical characteristics, and procedures performed during hospitalization. The post-intervention group was discharged 78 minutes earlier (14:00:32 versus 15:18:37, P=0.03) with a trend toward increased discharge by noon (94% versus 88%, P=0.09). Readmission rates did not differ (P=0.44). Conclusions Implementation of a focused, interdisciplinary, frontline provider-driven, enhanced communication program can be feasibly incorporated into existing specialty surgical workflow. The program resulted in improved timeliness of discharge and projected cost savings, without increasing readmission rates.

Impact of Structured Nurse Leader Rounds on Satisfaction With Nursing Care Among Patients With Cancer

“…Additionally, the findings of the study are consistent with the results of previous studies discussing the impact of the structured NLR and nurse leader practices on enhancing the coordination of care and the discharge process (Alaloul, Williams, Myers, Jones, & Logsdon, ; McIntosh et al, ). A structured NLR is an opportunity for the nurse manager to ensure that all discharge instructions, education, and coordination of care after discharge are in place before discharge (Eggenberger, Garrison, Hilton, & Giovengo, ; Page et al, ; Sharma et al, ).…”

Interventions to Prevent Readmissions in Hospitalized Peripheral Vascular Surgery Patients: A Systematic Review

“…Sixteen articles were excluded at this stage for reasons including: minimal number of vascular surgery patients in sample, or lack of readmission data specific to the vascular surgery population ( n = 7); lack of comparison readmission rate ( n = 4), lack of in-hospital or post-discharge intervention ( n = 3), or surgical intervention only ( n = 2). Six studies from these searches were included in the full review (de Mestral et al, 2019; Hornick et al, 2016; Mousa et al, 2019; Reed et al, 2004; Rümenapf et al, 2013; Sharma et al, 2017). A reference search of six potentially relevant secondary reviews identified from the initial search was also performed.…”

“…Decreases in average length of stay of 2.8 to 2.9 days was reported in two studies (Aicher et al, 2019;Reed et al, 2004). Interestingly in two studies the length of stay increased slightly post-intervention, but this increase did not reach statistical significance and tapered off over time (Rümenapf et al, 2013;Sharma et al, 2017). While the telehealth intervention by Mousa et al (2019) did not achieve significant readmission rate reduction, participants did report significant improvements in quality-of-life measures (p < .05) and trends toward improved satisfaction (p = .072).…”

Huddles and their effectiveness at the frontlines of clinical care: a scoping review

“…Of the 63.9% (N=101) studies measuring work and team process outcomes (Table 1), all but 1 reported that the huddle had a statistically significant positive impact on frontline staff. 6,8,9,[125][126][127][128][129][130][131][140][141][142][143][144][145][146][147][148]150,[153][154][155][156][157] Of these, studies found evidence for improved efficiency, process-based functioning, and communication across clinical roles (64.4%; N=65); 6,8,9,[125][126][127][140][141][142][143][144][145][153][154][155] improved situational awareness and staff perceptions of safety and safety climate (44.6%; N=45); 6,8,11,26,30,31,…”

“…Seventy studies (44.3%) measured clinical care outcomes 1,11,25,27,30,31,34,36,41,[49][50][51]56,63,72,74,86,89,94,97,[99][100][101]128,130,[132][133][134][135][136][137][138][139]141,144,[149][150][151][152]155,[157][158][159][160][161][162][163][164] , of which all reported the huddle had a positive clinical impact. Positive The CUS assertive statements help frontline staff speak up or speak out in uncomfortable situations.…”