discharge to door
DESCRIPTION
Discharge to Door. Kaizen #3. Team. Nurse Practitioner: Nurse: Pharmacist: Hospitalist: Radiology: Care Manager: Social Worker: Home Health: Accounting: PI Coach: Patient: Palliative Care:. Event Expectations. Document Current State Discharge Process - PowerPoint PPT PresentationTRANSCRIPT
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Discharge to Door
Kaizen #3
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Team
• Nurse Practitioner: • Nurse: • Pharmacist: • Hospitalist: • Radiology: • Care Manager: • Social Worker: • Home Health: • Accounting: • PI Coach: • Patient: • Palliative Care:
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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
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Current State Flow Chart
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Current State Flow ChartDischargeOrder
Written Nurse Secretary discovers discharge order in chartFirst time anyone knows discharge is eminent
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Major BlocksClinical Housing, Meds, Transportation
1st 4 Hours Next 4 + Hours
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Current State Flow Chart
Care Manager & Pharmacy
Social Worker
Bedside Nurse
DischargeOrder
NurseSecret-
ary
ChargeNurse
Care Partner
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Current State Flow Chart
Care Manager & Pharmacy
Social Worker
Bedside Nurse
DischargeOrder
NurseSecret-
ary
ChargeNurse
Care Partner
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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
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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
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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
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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
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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
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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
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Future State“Pending Discharge”
Order (24 Hrs inAdvance)
Social Worker
Bedside Nurse
NurseSecret-
ary
ChargeNurse
Care PartnerClinical
Dis-charge
Care Manager
Pharmacy
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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