Discharge BPR

8/3/2019 Discharge BPR

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Nobody willingly gets admitted in a hospital. To a person getting admitted,nothing is scarier than the sight and thought of OT and wards filled with sickpatients. To him, the moment he is certified fit for discharge, is the happiest andrelieving moment. Only he can explain the urge to get back home and be withhis family, but what comes in the way is the time taken to discharge the patient.

So, when the discharge time in a leading hospital is over five hours, then onecan understand what woes it can cause to patients.



In a location like Siliguri, where patients used to come from far-flung places, discharge time of five hours and 30 minutes had wide

repercussions. The whole family would wait for the patient to bedischarged and then due to delays, they would have to travel atnight which would unnecessary hassle. These complaintsincreased by each day.





Overview As the final step in the hospital experience, the discharge process is likely to be

well remembered by the patient. Even if everything else went satisfactorily, aslow, frustrating discharge process can result in low patient satisfaction. The discharge process is a critical bottleneck for efficient patient flow.Slow or unpredictable discharge translates into a reduction in effective bedcapacity and admission process delays. In fact, the discharge process andscheduling in-patient surgery rank as the two biggest factors impacting wait

times for in-patient beds.

Implementing the required changes for more efficient patient discharge can begreatly enhanced with the application of Lean Flow principles, as well as with asupporting Change Management Framework.



Discharge from a hospital does not necessarily indicate a return tohealth, but, rather, a move from acute care to alternate, lower intensityforms of care. In many countries, efforts to reduce health costs have led

to shortened hospital stays and a deliberate shift toward communitycare. Although there are a variety of services to meet the demand forcontinuing care, the transition from hospital to community is oftenproblematic. Patients and families report extended waiting times, limitedaccessibility, inadequate services, unmet needs, poor coordination,insufficient information, and lack of resources (Proctor, Morrow-Howell,

Li, & Dore, 2000; Waters, Allsopp, Davidson, & Dennis, 2001).



The objective of discharge planning is to provide safe and timelydischarges for hospital patients in transition to the community. It is a

complex process of enabling patients and their caregivers to make thetransition from hospital to community.• Is a quality link between hospitals, community-based services, non-government organizations, families and carers.• Involves assisting patients to return to the community safely with

necessary supports in a timely manner.

• Facilitates admission to the most appropriate level of care in thecommunity.• Begins prior to admission or as soon after admission as possible.

• Prevents readmission to hospital.

• Supports the patient and family in the discharge process



GOALS:• Finding the right bed at the right time in the right place

• Timely and safe discharges.

• Reducing LOS• Avoiding Readmissions



Identifying patients early in their hospitalizations who needdischarge planning to arrange special care dispositions is a

difficult task. Failure to achieve early identification mayresult in unnecessarily prolonged hospital stays and a lessorderly process of planning.



Medical or non medical reason may cause delay in discharge. It is reportedthat 30% of delay in discharge occurs due to non medical causes.

Poor communicationPoor organizationInadequate assessment of patient



A lengthy, inefficient process for discharging in-patients is a common

concern of hospitals. It not only causes frustration for patients and familymembers, but also leads to delays for incoming patients from Admitting, thePost Anesthesia Care Unit or the Emergency Department.



PRESENT PROCESS

Doctor inform party/sister Sister/ office

inform RMO

Prepare document

on BHT

Preparedocument onPC

Doctor forcheck

Billing

Section

Patient

Patient



Our Redesign Plan Discharge Summary:

The discharge summary is typed from the day the patient is admitted, isupdated on a daily basis and on the day of discharge, only minoradditional information is added.The summary is to be checked and signed by the consultant during hismorning visit to the patient on the day of discharge

On the day of the discharge, a final approval from the treating doctor

triggers the information to all stakeholders and the attendants to carry outwhat was necessary to enable the discharge of the patient in shortestpossible time.Since most of the work is already completed in advance, there is no lastminute chaos.



Our Discharge Team was constituted under the aegis ofDrA.K.Khandelwal,Medical Superintendent .This team was responsible to

design and implement systems to ensure timely discharge of patients.This team co-ordinated and constantly communicated with nurses on thepatient ward floor, front office assistants, billing executives, medicalofficers, admitting doctors and pharmacists.



Root Cause Analysis

A RCA was done to ensure improvement. After studying the existingprocesses for three months, the major causes for delays were identified.

Doctors' Round: This was to declare that the patient was fit fordischarge. The final nod was the main driver for the entire process. Thedoctors generally came for rounds at 10 AM. All the processes related todischarge started late. The nod would come by 11 AM and then thepatient would get discharged only by evening. "We could not tell thedoctors to start their rounds early, so we had to find other means to for

the entire process to complete quickly



Return of unused medication: After the final nod would come fromthe doctor in the morning, then only the unused medication would bereturned and the money would be deducted from the patients' bill.

Time taken by billing: The accounts department would take time toprepare the discharge summary and thus the bill. After the bill washanded over to the patients' relative, the patient would need time toarrange for money as the banks would open late. This delayed the timetaken by attendant to clear the final bill. Moreover, since in Siliguri,most patients come from nearby villages to get the quality treatment,

so the attendants take a long time to arrange for vehicles from theirvillages.



So, vital steps were taken to tackle the issue. Advance Information: Nurses were trained to confirm the date ofdischarge from the treating consultant during his rounds every day.. Once the date of discharge was confirmed by the doctor (to be the nextday), steps had to take place 12 hours before the day of discharge. "Allstakeholders involved were informed of the planned discharges.Unused medication of the patient was returned the previous night. Thepatients' attendants were informed, so that they could make therequired financial and logistic arrangements.





Daily Updating of Bills: To speed up of the billing process and to ensurequick turnaround of the final bills, all bills are audited and updated everynight to ensure minimum time is taken on the day of discharge. The aim isto complete all the discharges before 11am everyday, so that the samebeds could be made ready for the new admissions.



Discharge Summary: The discharge summary is typed from the day the patientis admitted, is updated on a daily basis and on the day of discharge, only minoradditional information is added. "The summary is to be checked and signed by

the consultant during his morning visit to the patient on the day of discharge,"explains Singh.

On the day of the discharge, a final approval from the treating doctor triggers theinformation to all stakeholders and the attendants to carry out what wasnecessary to enable the discharge of the patient in shortest possible time. Sincemost of the work is already completed in advance, there is no last minute chaos.



Upgrading IT: To ensure speedy processes, IT systems too wereupgraded. Some automation in the Hospital Information System (HIS)was brought in to enable a faster billing process as well as availability of

diagnostic reports online which ensured that there was minimal delay.Daily Payment: It is not easy to ensure that the attendants are readywith the balance of the payment and logistic arrangements. "So,whenever there is a credit from the patients' side, the attendant is askedto pay the amount on a daily basis, so that in the end there is not a bulkof payment to be made," says Singh.





REDESIGN PROCESS

Discharge document is created on the day ofadmission

Document is updated periodically

When party wants discharge



Benefits of Quick Discharge The patients get discharged much before the new set of admissions takeplace and the hospital is able to turn around more beds for new admissions.

The operational efficiency has increased and as a result the patient

satisfaction index has also gone up as the hospital now rarely denies anadmission due to non-availability of beds. Neither do the patients have towait for allocation of a bed unless the hospital is completely full.

The consultants are happy because their patients are satisfied and they canfocus all their attention towards providing care to their patients.

Documents

Discharge BPR