From the 2024 HVPA National Conference
Catherine Miller MSW (University of Maryland Medical Center, Downtown Campus), Michelle Adelstein ACNP
Background:
The R Adams Cowley Shock Trauma Center, one of the United States’ highest-volume trauma centers and the Primary Adult Resource Center for the state, annually serves over 6,500 critically ill and severely injured patients, necessitating a focus on safe and efficient patient throughput.
In FY23, our average length of stay (LOS) was 10.49 days, with an LOS O/E ratio of .88 (compared to a similar CMI group with an average LOS of 11.88 days). Additionally, our average discharge time was 3:14 pm, prompting a desire to decrease LOS O/E, advance our average discharge time, and achieve discharges before noon. To enhance discharge efficiency, we aimed to increase transparency in the discharge process for all team members.
In May 2022, we developed and operationalized an EMR tool called Discharge Milestones, offering insight into key discharge milestones, including estimated discharge dates and involvement of various departments such as PT, OT, SLP, CM, and SW. Subsequently, in May 2023, we incorporated workflows to indicate medical readiness for discharge.
Objective:
Our objective was to enhance patient throughput efficiency by implementing Discharge Milestones and Medically Ready processes for the interdisciplinary team, thereby reducing average LOS and LOS O/E, increasing discharges by noon, and advancing discharges earlier in the day.
Methods:
Initially, we formed an interdisciplinary team, termed The Discharge Task Force, comprising social work, case management, therapies (PT/OT/SLP), charge nurses, nursing coordinators, physician leaders, nurse practitioners, and transitional care coordinators. This team convened monthly to optimize the utilization of a new EMR tool providing transparency into necessary discharge steps and identifying barriers.
We then addressed these barriers and improved interdisciplinary communication early in the day by utilizing an EMR indicator for medical readiness. To further enhance interdisciplinary coordination, we transitioned our daily telephone call-based interdisciplinary rounds into a mandatory in-person one-hour-long meeting with representatives from each discipline.
Additionally, we optimized the utilization of the Discharge Center, where patients await transportation and discharge medications.
Results:
We observed a 7.8 percentage point increase in DC orders by 9 am, reaching 21.3%, and a 7.3 percentage point increase in discharges by noon, reaching 18%. Furthermore, we reduced the average LOS to 10.28 days and LOS O/E to .85, equivalent to creating four additional beds per month (IHI White Paper Patient Flow ROI Solution 2012).
Conclusions
Implementing EMR tools to enhance interdisciplinary communication and coordination can effectively increase throughput by reducing length of stay and facilitating earlier discharges.
Data: Graphics
References:
Abuzied, J, Maymani, H., Aimatouq, B, and AlDosary O. (2021). Reducing the Length of Stay by Enhancing the Patient Discharge process: Using Quality Improvement Tools to Optimize Hospital Efficiency. Global Journal of Quality and Safety in Healthcare, 4(1):44-49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10229011/
Perry, M. Macias, C, Chaparro, J, Heacock, A. Jackson, K. and Bode, R. (2020). Improving Early Discharges with an Electronic health Record Discharge Optimization Tool. Pediatric Quality and Safety. 5(3):May-June2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297394/
Rutherford PA, Anderson A, Kotagal UR, Luther K, Provost LP, Ryckman FC, Taylor J. Achieving Hospital-wide Patient Flow (Second Edition). IHI White Paper. Boston: Institute for Healthcare Improvement; 2020.