Discharge to Door

Kaizen #3

2

Team

• Nurse Practitioner: • Nurse: • Pharmacist: • Hospitalist: • Radiology: • Care Manager: • Social Worker: • Home Health: • Accounting: • PI Coach: • Patient: • Palliative Care:

3

Event Expectations

1. Document Current State Discharge Process

2. Develop a Future State Discharge Process

3. Capture “Before” Event Metrics

4. Create Discharge Audit Form & Team

5. Develop Action Item List

6. Develop Final Presentation

4

Current State Flow Chart

5

Current State Flow ChartDischargeOrder

Written Nurse Secretary discovers discharge order in chartFirst time anyone knows discharge is eminent

6

Major BlocksClinical Housing, Meds, Transportation

1st 4 Hours Next 4 + Hours

7

Current State Flow Chart

Care Manager & Pharmacy

Social Worker

Bedside Nurse

DischargeOrder

NurseSecret-

ary

ChargeNurse

Care Partner

8

Current State Flow Chart

Care Manager & Pharmacy

Social Worker

Bedside Nurse

DischargeOrder

NurseSecret-

ary

ChargeNurse

Care Partner

9

Data Analysis

• 59 Patients chosen at random from thousands

• January patients chosen since their records would be complete

• Measuring time from Doctor’s (discharge) order to time patient was checked out of system

10

January 2010 Data

Average Discharge Time by Unit

548505

458

378 369

297268

0

100

200

300

400

500

600

Unit

Un

it A

ve

rag

e in

Min

ute

s

Unit Average 548 505 458 378 369 297 268

4W 2W 2E 6W 6E 5W 5E

9.1 Hrs 8.4 Hrs 7.6 Hrs 6.3 Hrs 6.3 Hrs 5.0 Hrs 4.5 Hrs

11

Time to Discharge

26%21%

15% 15%

6% 6% 4% 6%

0%0%5%

10%15%20%25%30%

Minutes

% o

f Dis

char

ges

January 2010 Data

47% 53%

1st 5 Hours Hours 6 - 33

12

Discharges by Time of Day

1

5

13

3

13

6

7

2

5

2

0

1

00

2

4

6

8

10

12

14

Befor

e Noo

n

Noon -

1300

1301

- 14

00

1401

- 15

00

1500

- 16

00

1601

- 17

00

1701

- 18

00

1801

- 19

00

1901

- 20

00

2001

- 21

00

2101

- 22

00

2201

- 23

00

2301

- 24

00

Time of Day

Nu

mb

er o

f D

isch

arg

es

January 2010 Data

Noon

13

30 Day Action Items

Item Action Owner Due

1 Flag D/C patient’s charts & review immediately after STAT charts

Julie

2 Develop standardized D/C process for use hospital-wide

Robert

3 Process all ancillary orders as STAT

Debra

4 Scan D/C Med orders STAT Shelly

5 Develop & Beta test “white board”

Stephanie

6 Case Manager & Social Workers begin preparing multiple placement options

Darlene

14

30 Day Action Items (2)

Item Action Owner Due

7 Develop & use D/C checklist for all disciplines

Robert

8 Print In-Patient Med labels for use post discharge (avoid re-labeling)

Shelly

15

Future State“Pending Discharge”

Order (24 Hrs inAdvance)

Social Worker

Bedside Nurse

NurseSecret-

ary

ChargeNurse

Care PartnerClinical

Dis-charge

Care Manager

Pharmacy

16

Event Outputs

√

√

√

√

√

X

• Document Current State Discharge Process

• Develop a Future State Discharge Process

• Capture “Before” Event Metrics

• Create Discharge Audit Form & Team

• Develop Action Item List

• Develop Final Presentation