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Discharge to Door Kaizen #3

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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 Presentation

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Page 1: Discharge to Door

Discharge to Door

Kaizen #3

Page 2: Discharge to Door

2

Team

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

Page 3: Discharge to Door

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

Page 4: Discharge to Door

4

Current State Flow Chart

Page 5: Discharge to Door

5

Current State Flow ChartDischargeOrder

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

Page 6: Discharge to Door

6

Major BlocksClinical Housing, Meds, Transportation

1st 4 Hours Next 4 + Hours

Page 7: Discharge to Door

7

Current State Flow Chart

Care Manager & Pharmacy

Social Worker

Bedside Nurse

DischargeOrder

NurseSecret-

ary

ChargeNurse

Care Partner

Page 8: Discharge to Door

8

Current State Flow Chart

Care Manager & Pharmacy

Social Worker

Bedside Nurse

DischargeOrder

NurseSecret-

ary

ChargeNurse

Care Partner

Page 9: Discharge to Door

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

Page 10: Discharge to Door

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

Page 11: Discharge to Door

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

Page 12: Discharge to Door

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

Page 13: Discharge to Door

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

Page 14: Discharge to Door

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

Page 15: Discharge to Door

15

Future State“Pending Discharge”

Order (24 Hrs inAdvance)

Social Worker

Bedside Nurse

NurseSecret-

ary

ChargeNurse

Care PartnerClinical

Dis-charge

Care Manager

Pharmacy

Page 16: Discharge to Door

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