Inves&ga&ng the Usage of an Es&mated Date of Discharge for Occupancy Workflow
Improvement Flores, K1., Lo, A1., Sla0ery, D1., DasGupta, T.2, Gagliardi, L.2
1. University of Toronto IHI, 2. Sunnybrook Health Sciences Centre
Sunnybrook’s overarching goal is to reduce occupancy of acute care beds, however the discharge strategy focuses on: -‐ Early communicaMon (from admission) of the
discharge plan to paMent and family -‐ IdenMfying potenMal factors that can lead to a
problemaMc discharge as early as possible, throughout the paMent care period
Introduction
Objectives
Methods
Results Results
Conclusion
Acknowledgements
Sunnybrook Health Sciences Centre is frequently experiencing occupancy rates that exceed 100%. A focus area leading to high occupancy rates is the discharge process which, upon admission, handles how and when paMents leave the hospital. There exists a need to ensure that all paMent and family concerns are met up unMl discharge, while at the same Mme ensuring that a Mmely paMent flow and high quality, person-‐centered experience is maintained.
It was determined that communicaMon of an EsMmated Date of Discharge (EDD) would be beneficial to both the paMent family and healthcare staff to improve discharge workflow. The following intervenMons were measured to determine EDD effecMveness: 1. UpdaMng paMent bedside whiteboards with the EDD
to encourage proacMve idenMficaMon of concern 2. Care round script (a 4 quesMon tool to help support
discharge and person centered care discussions) 3. Feedback from paMents via inpaMent interviews and
post-‐discharge phone call surveys
10 20
286
1 18
EDD Barriers within Sunnybrook control -‐ Between Jan 12th & Mar 31st
Total 337 whiteboards
OR
Receiving Treatment
Care Decision Pending
WaiMng for Consult
Insufficient Materials
Figure 1: Barriers to why EDD could not be discussed to paMents via whiteboard
Figure 2: Results of the care round script to foster discussion of paMent discharge
Early feedback from discharged paMents show that only 25% reached the DB11 goal (Fig. 3), however more data is required to determine if improvement is being made. Major barriers to discussing EDD’s were discovered (Fig. 1) and should further undergo deep dive analysis. One notable menMon is that paMents oben disliked the idea of discussing an EDD during admission or the early stages of care. Most paMent comments pertained to their own well being, such as what they need to do in order to stay healthy outside of hospital and only 20% valued being told an EDD (Fig. 3) within the first day of their admission. Next steps could include the creaMon of a process map that captures all current discharge processes. This type of analysis would facilitate accurate idenMficaMon the processes in greatest need of improvement, and would help demonstrate how the those processes affect the others.
We would like to thank Tracey Das Gupta, Lina Gagliardi, Florina Weisenberg, and Therese Loo for the opportunity to parMcipate on the Discharge Working Group, and for their conMnuous effort in helping us along the way.
63%
81%
79%
72%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Script Followed
Person’s goals/concerns discussed
EDD Discussed
Team Member iden&fied for follow-‐up
% From Total
Que
s&on
s
Care Round Compliance 5 Weeks (Between Jan 20th and Mar 27th)
Total of 1,031 pa&ents
Units: B4, C2, C4, C5, C6, D2, D3, D4, D5, D6ENT and D6URO
Figure 3: Feedback from paMents, post-‐discharge
Table 1: Most common comments/concerns from inpa&ent experience surveys Home care (ex. How do I cope living at home?)
Family GP Involvement
TransportaMon (ex. who will pick me up to return home or move to LTC?)
Equipment (ex. How do I obtain a walker?)
CCAC CoordinaMon – start the process when paMent is admi0ed
24%
20%
45%
25%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Told EDD during admission
EDD within 24 hours valuable?
Delays during discharge?
Discharged before 11?
% From Total
Que
s&on
s
Post discharge pa&ent surveys Total of 21 pa&ents
May 2, 2015
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