Critical Path Network
Throughput initiatives lower discharge time by two hours
Improved RN, CM communication is the key
Through a series of initiatives aimed at increasing patient throughput, Bay Medical Center in Panama City, FL, has lowered its average discharge time by two hours.
Initiatives include case managers and charge nurse rounds in the morning and at the end of the day, discharge areas for patients waiting to go home or to a nursing home but with transportation delays, and a team approach to discharge planning.
But perhaps the most important factor in the success of the initiative is increased communication among members of the treatment team, says Delilah Dennis, RN, manager of resource management at the 433-bed regional hospital.
"There was a divergence in priorities for case managers and nursing. Case management is focused on the care throughout the stay, throughput, and discharge while nursing's focus is clinical bedside care," she says.
The nursing units tried convening a team meeting twice a week in which nurses and case managers could sit down and talk. It worked well in some units, but there was inconsistent commitment in other units, Dennis reports.
The hospital contracted with Compirion Healthcare Solutions, a consulting firm specializing in process improvement, to help improve communications between the two disciplines with a goal of improving patient care and patient throughput.
"We instituted a lunch-and-learn series to teach each discipline about the other's role and to get them started talking to each other," says Joyce Evans-Bailey, RN, MBA, who developed a six-week course to teach charge nurses and case managers about the role each play in the hospital.
"The charge nurses didn't understand DRGs, avoidable days, reimbursement issues, or why the hospital is trying to tighten its belt. They needed to see the whole picture and understand that when a person doesn't meet continued stay criteria, he has to go home. Now they know that we are looking at what is best for the patient as well as the hospital's bottom line. It's helped us build a team that works together on patient care issues," Dennis adds.
Following the educational sessions, the hospital instituted 30-minute case manager and charge nurse rounds on every unit during which they discuss all the patients on the unit, who might be ready for discharge, and what has to be done before the discharge can occur.
"Having the case manager sit down with the charge nurse on each unit has helped us get rid of walls and communicate better. They work together and discuss how to speed up the discharge process, and as a result, our patient throughput is improving and the length of stay is dropping," Dennis says.
The process started out on the medical unit, which has many very sick patients, many of whom have long lengths of stay, and was rolled out through the entire hospital, Dennis says.
"At the morning meetings, we talk about who is going home that day, what tests or procedures they need, which patient needs orders for post-acute care, and any issues that might delay the discharge. Now when a patient needs orders for a nursing home or home health referral, the charge nurses help the case manager locate the doctor and get the orders. They help talk to the family to get them ready for the discharge. We're all working toward the same goal," Dennis says.
Everybody on the team works together to lower the discharge time of day, she says.
For instance, in many cases, the family members come to see the patient after 5 p.m., after the case managers have left for the day. Now, the nursing staff, which works a 7 a.m. to 7 p.m. shift, alerts the family that the patient will be ready to go home the next day and that they should make arrangements to pick them up.
"The constant communication helps ensure that everybody is on the same page. Everybody knows this is our plan and we can start getting the patient ready to go home. It alerts the case managers to give patients the Important Message from Medicare and alerts the nurses of tests or procedures that are pending," Dennis explains.
The charge nurses and the case managers meet again at 1:30 before the afternoon bed board meeting to look at discharges planned for that day and those anticipated for the next day.
"They look at who was supposed to be discharged but hasn't gone home and what the holdup is. They discuss the patients who are scheduled for discharge the next day so the nurses can start the paperwork and alert the family members as they come in to visit after work," Dennis says.
The charge nurses take the information to the bed board meeting so plans can be made for the next day.
The team meets again at the end of the case management shift to discuss what has to happen overnight so the patient can go home the next day.
"These meetings help alert the nurses to be on the lookout for the test results or X-rays. The units get so busy that they may forget something is pending, like holding a patient NPO for a test so that when the results are in, he can be discharged the next day," Dennis says.
Through a series of initiatives aimed at increasing patient throughput, Bay Medical Center in Panama City, FL, has lowered its average discharge time by two hours.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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