Re-engineering Discharge Process
[Editor's note: The Society of Hospital Medicine's Project BOOST seeks to improve the hospital discharge process and create safer transitions for adults by encouraging hospitals to create multidisciplinary teams, use proven tools, and work with mentors. In this issue of Discharge Planning Advisor, we have several articles discussing Project BOOST and how it has helped some of its earliest hospital participants. In the November/December issue, there will be additional stories about the project.]
Project BOOST has produced early, positive results for involved hospitals
Its tailor-made toolkit helps
The hospital discharge process is receiving the attention it deserves with a new national project that seeks to improve health care transitions for all adults in the United States.
The Philadelphia-based Society of Hospital Medicine's Project BOOST, which stands for Better Outcomes for Older adults through Safe Transitions, has become very popular and has achieved some success in its first year of inspiring and assisting participating hospitals with making discharge process changes.
"It's funded by a grant, and we at the University of New Mexico were one of several pilot sites," says Percy Pentecost, MD, assistant professor of medicine at the University of New Mexico Hospital in Albuquerque, NM.
The hospital's interest in Project BOOST stems partly from a recognition that hospital medicine has become very complex, and health care systems need to ensure a greater continuity of care when patients are discharged, Pentecost notes.
"I think back to when I was a kid and my father was admitted to the hospital," Pentecost says.
"His doctor admitted him in the hospital, saw him in the hospital, discharged him from the hospital, and provided great continuity of care," he explains. "Now a quarter century later, things are much more complex, and so we're trying to recapture this true continuity of care while dealing with more complexities in the system."
Project BOOST was developed with funding from the Hartford Foundation as a way to help hospitals implement system changes in their discharge process, says Tina Budnitz, MPH, senior advisor for the Society of Hospital Medicine.
Discharge planning often is problematic for hospitals, and it's not because physicians and other health care professionals do not understand what the best practices are, Budnitz says.
"The gap is being able to change the system to implement those best practices," she explains. "What we have found when we looked at hospitals is there's a tremendous range in terms of who owns the discharge process and a tremendous range in terms of their resources."
Health care today costs too much, and the outcomes aren't as positive as they should be, another expert says.
"So, like any industry, we have to figure out how to do it better, faster, cheaper, and safer," says Matthew Schreiber, MD, medical director for hospitalist services for the Atlanta-based Piedmont Healthcare and interim chief medical officer for Piedmont Hospital.
"We need to make sure that everyone who interfaces with patients feels like they're responsible for making the patient's outcomes as good as it can be," he adds.
Project BOOST primarily looks at creating successful discharges, including preparation for discharge, Schreiber says.
For instance, an important piece of the project is a risk assessment form that addresses problem medications, depression, and other issues that should be considered at discharge, he says.
"The discharge process in hospitals is a scary time for patients," Schreiber says. "So, we have to fix the discharge process and make it safe for patients, because it's the right thing to do."
For example, a male patient who is highly medicated and has ample access to resources in the community won't be as much at risk as an older male patient who has no social support, 10 different medications, and three different medication problems, Schreiber says.
"BOOST is focused on discharge, but managing a successful discharge includes critically evaluating your patient population, selecting the patients you need to spend the most time on, and making sure someone is taking all the necessary actions to reduce patients' risk exposure," he adds.
Schreiber sees Project BOOST as a good way to start improving the discharge process and hospital outcomes.
"The reason we got involved was because I was interested in taking a very critical look at the entire spectrum of patient care and our process in the hospital," Schreiber says.
"We realized the discharge piece of the patient experience was pretty big and broken, and we'd have to do something to manage it," Schreiber explains. "So BOOST fell out of the sky and had the paper tools to help you manage the discharge process and make it better."
Confronted with a choice of doing the foundation work from scratch or taking Project BOOST's tools and infrastructure, which had been developed with experts, it was an easy decision to participate in BOOST, he adds.
"We were interested in setting up a geographically designated hospitalist unit, which is fairly popular these days," Schreiber says. "With the hospitalist model we place the patient with the attending physician, so if the hospitalist is the attending on record, the patient is placed in the hospitalist's unit."
The idea is to put patients all in one location, he adds.
The old way of handling rounds had physicians rounding on 15-20 patients who were scattered throughout the hospital, Schreiber says.
Physicians would spend 45 minutes just walking to various patient locations, he adds.
With the hospitalist model, the hospital places patients with the attending physician, meaning the physician conducting rounds has all of his or her patients in one location.
"By putting all 15 patients in one location, you eliminate that 45 minutes of time, and it enhances the visibility of staff and patients," Schreiber says.
"The patient's perception is 'My doctor is very available to me, and I can reach him by sticking my head out in the hallway and saying I need him,'" he adds.
This change, instigated by Project BOOST, reduces the time spent on patient rounds, provides physicians with a greater sense of ownership over patients' care, and makes providers responsible for patients' transitions out of the hospital, Schreiber says.
"One of the revolutions of BOOST is you have in the hospital care providers saying they're responsible for what happens to patients, even after patients have left the hospital," he explains. "That's a major shift in philosophy and ownership."
Both physicians and patients have expressed greater satisfaction since the change, he notes.
The University of New Mexico Hospital began working on its initial steps with Project BOOST last fall, including looking at process mapping, following patients during the discharge process, Pentecost says.
Process mapping can be very enlightening to an organization, he says.
"Everybody has their own perspective, and when you get everyone together in a room describing the process you have a 'eureka' moment of 'Oh, that's why you do that! I had no idea,'" Pentecost says.
It takes a while for a hospital to analyze, assess, and improve its discharge process, he notes.
"It's been a long process, and the project sets us up with a mentor," Pentecost says. "And the first thing we did was have a couple of conference calls with our mentor to discuss some of the foundation steps, such as assembling a team and acquiring administrative support."
The changes Piedmont Hospital has made as part of Project BOOST have been fully appreciated by patients, Schreiber says.
"They are more satisfied with their care, and they have better outcomes," he adds.
Physicians also are more satisfied because the changes have brought back what has been missing from their medical practice, he notes.
"Physicians haven't gotten much satisfaction out of practicing medicine [in recent decades] with all of the reimbursement changes," Schreiber says. "This re-invigorates their passion for medicine and taking care of patients."
SOURCES
For more information, contact:
Tina Budnitz, MPH, Senior Advisor, Director for Project BOOST, Society of Hospital Medicine, 1500 Spring Garden St., Suite 501, Philadelphia, PA 19130. Telephone: (678) 694-1022. Email: [email protected]. Web site: www.hospitalmedicine.org/BOOST.
Percy Pentecost, MD, Assistant Professor of Medicine, University of New Mexico Hospital, Albuquerque, NM 87131. Telephone: (505) 272-2147. Email: [email protected].
Matthew Schreiber, MD, Medical Director for Hospitalist Services for Piedmont Healthcare; interim Chief Medical Officer, Piedmont Hospital, 35 Collier Road, Suite 634, Atlanta, GA 30309. Telephone: (404) 367-3014. Email: [email protected].
The hospital discharge process is receiving the attention it deserves with a new national project that seeks to improve health care transitions for all adults in the United States.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content