From the 2019 HVPAA National Conference
Mrs. Olukemi Akande (Yale New Haven Hospital), Ms. Caitlin Sculley (Yale New Haven Health), Mrs. Trish Babcock (Yale New Haven Health)
Background
At Yale New Haven Hospital (YNHH) there is a much lower incidence of patient discharges on weekends and Mondays compared to any other day of the week. There is also a correlation with the day of the week of admission and associated length of stay (i.e. admissions on Wednesdays have greater lengths of stay). With a focus on Medical Units, there is a higher length of stay of patients than expected which are also associated with higher patient safety issues. The Care Management team helps in facilitating and identifying patients ready for discharge, however there is currently very low staffing on the weekends, attributing to the decreased discharges and increased length of stay.
Objective
Efficiently facilitate discharge planning with a focus on weekends to decrease the hospital LOS and increase the # of patients discharged per day at YNHH.
Methods
Gathered multi-disciplinary stakeholder group to perform a gap analysis, identify barriers in the current state and then designed the future state around the following interventions with SMART (specific, measurable, achievable, relevant and time-based) goals:
• Enhance Discharge Planning on Weekends/Mondays
o Implemented a staffing pilot on 3 medicine units with dedicated Case management staff for these units. The main goal was to identify patients eligible for discharge from a Case Management perspective and partnered with providers, rehab, nursing, skilled nursing facilities and insurance companies to facilitate expedited discharges.
o Instituted daily huddles to discuss patients eligible for discharge and logistics to facilitate discharges, which occurred twice daily on weekends. Participants at these huddles included: Case Management, Providers, Physical Therapy and Nursing.
o Improved electronic and in-person communications between care teams.
• Enhance early Discharged Planning:
o Epic optimizations were created for Case Management to identify all elements required for Case Management discharge readiness with transparency to the entire care team.
o Created agreements with local transportation companies to schedule pick-ups proactively instead of waiting for day of transportation requests.
• Optimize Acceptance to SNFs on weekends
o Gain consensus for acceptance on weekends with Skilled Nursing Facilities.
o Partner with insurance companies to accelerate or forgo authorization processes on weekends.
Results
The case management project achieved a 21% improvement in facilitating discharges prior to 11 am and an 8% increase in accurately identifying patients discharge readiness were observed during the pilot on the weekends and Monday. Through the interventions listed above, 94% of Providers were satisfied and saw great benefit with the case management support. Collaboration between Care Management, Providers and Physical Therapy improved the weekend discharge planning process. In addition, optimization of SNF acceptance on the weekends were critical to the success.
Conclusions
Increase in Case Management support, proactive discharge planning and weekend collaboration/huddles with medical providers, rehab and nursing, improved hospital throughput on weekends and Mondays, while increasing the reliability of the discharge readiness colors used to trigger other hospital operations such as environmental services and bed management.
Clinical Implications
These interventions helped improve safe transitions on the weekends, while improving provider satisfaction. The expectation is that patient satisfaction will be improved as well, since higher weekend and 11am discharges facilitate patients getting into the right bed at the right time.
