Eliminating Discharge Delays
ELIMINATING DISCHARGE DELAYS
Delays in discharging patients is a major issue affecting a majorityof hospitals. It takes around 5 to 6 hours for a patient to bedischarged in most of the hospitals (Challis et al., 2014). This isusually caused by the hospital requirement of discharge clearancefrom different departments ranging from the ward management to thefinance department. Lack of coordination between the involved medicalstaff can also prolong the discharging process (Challis et al.,2014). These delays leads to hospital operational inefficiency andincreases cost for the patient. Such delays in discharging, impactsnegatively the patient flow in the hospital (Graban, 2016). There arevarious techniques that a hospital can implement to eliminate/ reducedischarge delays. They include: automating hospital processes,improving the bed management system, and proper patient planning.
Automating hospital processes requires the hospital to procure asystem that is centralized, and can be accessed by all the hospitaldepartments (Allen et al., 2017). This enhances coordination amongthe medical staff and improve communication. The system also enablesa quick clearance of discharged patients from the relevantdepartments as well as improve hospital efficiency. Improving the bedmanagement system of the hospital ensure a smooth flow of patient(Hall, Belson, Murali and Dessouky, 2013). Once a patient isdischarged, the information should be passed on to the admissiondepartment notifying them of an unoccupied bed, hence reducingadmission time for patients. Planning for patients during admissionall through to discharge can also reduce discharge delays (Page,Lederman, Kelly, Barry and James, 2016). This will involve recordingthe patient bills once they are incurred and reducing the time takento calculate the total bill. The system also ensure that properbilling information is available when the patient is discharged.Automation of hospital operations is by far the best method ofeliminating discharge delays (Lenzi, Mongardi, Rucci, Di Ruscio,Vizioli, Randazzo and Fantini, 2014). A hospital must invest in apowerful management system which will have other benefits other thanreducing delays. The system will lower hospital costs, as well asenable/enhance communication between the medical staff. This can alsoimprove the patient`s experience within the hospital which willimprove the hospital`s reputation while ensuring customersatisfaction. The main aim of this paper is to discuss and formulateways in which delays in discharging patients from hospital can bereduced. The paper will also discuss the impact brought about bydischarge delays to a hospital in terms of monetary value andorganization reputation.
This review purposes is to identify the systems, models,interventions, or policies that are considered supportive andfruitful for good practice in the prevention and management ofdelayed hospital discharges. Healthcare systems that depend onperfect human performance are fatally flawed (Spath, 2013). Followinga systematic and thorough screening and search of literature that isempirical, the evidence of high level has been identified assupporting this position. Examples of the evidence includemeta-analyses, recent randomized controlled trials, and systematicreviews, among others. As a result, delays in discharges can bemanaged with utmost commitment and cooperation between all thehospital facets that are involved in rendering health care. Variousstrategies can be employed by hospitals to improve the dischargeprocess integrated systems which span activities in hospitals,post-discharge facilities, and services that are home based,interdisciplinary approaches to service delivery and assessment,need-related individualized services, specialist follow-up, anddischarge support initiated by the hospital among others (Marvin, Kuoand Linnard, 2013).
Vast tracts of evidence with the inclusion of meta-reviews ofclinical interventions suggest that generally, there is positivity inthe effectiveness of the systems that are integrated spanning thecommunity and acute settings (Erdogan, Robinson, Blake, & Johari,2013). Its purpose is to have assessments in the hospital beforedischarging the clients. Some of the methods involved include the useof medication reconciliation, coordination of care among theproviders of post-discharge services and the hospital, liaisonbetween nurses and other specialists of coordinating care, and theassessment after discharge, among other strategies (Feigal et al.,2014). The aim of these interventions is also to redirect the burdenof hospital readmissions as a way of delaying the discharge process(Joseph, Brown-Manhertz, Ikwuazom, Santomassino and Singleton, 2014).Some of the findings available for the use of this method inintervention include the transitional care for the older patientshaving chronic diseases. Their readmissions and hospital stay wasreduced due to the increase in the follow-up periods. The provisionof communication and information transfer to primary from acute carehas helped in the reduction of the delays in discharge (Joseph etal., 2014). This has been proved in the context of Ireland. Thehospitals have integrated the centralization of patient informationtransfer and the use of encrypted and secure sharing of patientinformation in hospitals.
There is the evidence that convinces the use of approaches from amultidisciplinary team that is multifaceted. They target theassessment, diagnosis, and the provision of care to lower the lengthof stay of a patient. It encompasses patient planning and theutilization of a more diverse transitional care (Coffey,Leahy-Warren, Savage, Hegarty and Cornally, 2016). The methodsinvolved include a comprehensive discharge support, management ofcases, and health promotion (Marvin et al., 2013). This approach hasbeen identified as vital in the cases of complex social and healthcare needs. These cases require a detailed planning, assessment andthe administration of care. Moreover, Irish hospitals have reportedan improvement in discharging patients when baseline assessment(s),integration of the care of geriatric patients, collaboration amonghospitals, and the transfer and sharing of electronic patient dataare utilized. To this extent, the intervention has been employed inother areas such as Australia and the United States of America due toits effectiveness (Coffey et al., 2016).
Clearly, the previous reviews have presented interventions that havea positive impact on the control of the patient discharge process andemphasis has been inclined towards individualized care, assessment,and services (Clarke & Tinsley, 2012). Interventions oftransitional care have a positive effect in lowering delays indischarging patients. Individualized care endeavors to hasten thehealing process and shorten the activities involved in clearing thepatient. This approach has also been used in Ireland and other areas.For instance, John Hopkins hospital has integrated the electronicdata storage with individualized care so that the patient does notneed to undergo much clearing processes (Clarke & Tinsley, 2012).
The hospital support and dedication of personnel in the managementand coordination of the patient transition from the hospital to thedestination of discharge and follow-up have been useful in loweringthe delays. Some of the involved methods include discharge planningby nurses, bridging the interventions, power transition, andnavigation transition (Erdogan et al., 2013). Among the major issuesinvolved in reducing delays in discharging patients include theelimination of read missions. Researchers recommend the use oftechnology in home monitoring. Some of the methods include continuousmedical education on the efficiency of care (Joseph et al., 2014).
In conclusion, the systems, models, and interventions necessary forthe reduction of delays in discharging patients include the use ofintegrated systems, interdisciplinary collaboration and management,the utilization of individualized care, and discharge support fromthe hospital, among other interventions. Moreover, otherinstitutional-based methods that delay the process of dischargingpatients need to be eliminated. For instance, rendering highlyspecialized care to reduce readmissions and the use of technology isalso important. Some of the interventions have been tried indeveloped countries like Ireland among others. Additionally,health-related issues need to be improved in various aspects so thatthe discharge process is effected in the hospital settings.
Discharge delays can lead to additional costs at the hospitalsbecause the patients will continue to stay in the health carefacility beds. It leads to increased costs which are an added burdento both the patients and the hospitals. To curb this challenge, thePlan-Do-Study-Act (PDSA) cycle was recommended in the practicumpaper. It is of great significance to describe the PDSA model andexplain why it was selected.
The Plan-Do-Study-Act (PDSA) model is used to test a change where aplan to test it is developed, tested, consequences observed andlearned, and the possible modifications are recommended (Acton,2013). Four steps are involved in this strategy, and they includePlan, Do, Study, and Act. In planning, the discharge coordinatorswill come up with the change and then predict the possible outcomethrough this cycle. Numerous decisions must be made at this initialstage like deciding on the particular data that must be collected tofacilitate decision-making. Those responsible for the collection aredetermined and issues regarding the time and place of implementingthe alteration are defined (Barach, Jacobs, Lipshultz and Laussen,2015). In the Do stage, the modification is executed, propermeasurements are made, and the specified data is gathered. The staffin charge of measuring has to understand the information to collectand the methodologies to use. In the course of assembling, the agreedrefine is then added. However, if the changes are more than one, oneof it is added at a time. In the study stage, a precise analysis isdone before the refining and after to find out what can be learnedfrom its implementation. This gives an opportunity to determine thechances of success and failure. The coordinators will give ideas howeach and every one experienced it. In the last step, a decision ismade whether to adopt the change or come up with something newinstead. For the choice to be productive, 90% of the coordinatorsmust support it (HQIP, 2015).
There are numerous reasons behind the selection of this process. Itgives the administrators an opportunity to test the modifications ona small scale and find out whether it serves the intended purpose.However, if it fails to, then they will learn why so and the correctcourse of action. Similarly, the staffs are not limited to any onetechnique, and as a result, they can try some other ways thatincrease the efficiency of their operations in the long-run. This ispossible as their views are taken into consideration (The King FundOrganization, 2017).
Furthermore, as the coordinators have the responsibilities ofcreating the ideas meant for improvement depending on the reality ofdaily activities, they will get committed. They dedicate their timeand effort to fulfill this task to the best of their knowledge.Lastly, the method helps solve the problem of recruiting staff totake part in the exercise. PDSA cycle ensures that the participantsare situated in positions where their contribution is maximized. Asthe clinical and non-clinical teams are involved, a range ofperspectives are gathered to make the final decision (Institute forHealth Improvement, 2017).
Delayed discharge continues to be an issue to the hospitalmanagement, and only a clear method can help solve it. PDSA modelwill put everything into a test before deciding to use it in theclinical setting. Every member is free to give ideas over what he haslearned from the trial that can add value to the final solution.Questionnaires will be used as a quality performance analytical toolto analyses the efficiency of system implementation in variousinstitutions. Both the patient and nurses will be required to answerquestionnaires to ascertain the level of satisfaction achieved toboth parties.
Providing high quality and sustainable health care requiresidentification of innovative models, systems, interventions andmaking informed choices on the degree of applicability of establishedchange (HQIP, 2015). It is possible to significantly reduce or managedelays in discharges if the entire stakeholders in the health caresectors are involved in making necessary changes. Centralized cares,coordinating care, liaison between health specialists and nurses,communications and adequate follow-up have been found to reducedelays in discharges (Graban, 2016). However, the approach will behighly successful if it is done in a team such that it ismultifaceted and multidisciplinary. Change implemented in the healthcare sector ought to be sustainable in that it reflects the needs ofpatients for it to be supported. If the change fails such a test isoutlawed, and the team has to look for the more appropriate approach(Gregory, 2015). This need underscores the need for an efficientmodel that can be used to not only test but accelerating qualityenhancement. This study will review the application ofPlan-Do-Study-Act (PDSA) cycle to evaluate changes that are made toreduce delays in discharge and lessen the duration of stay inhospitals.
Delayed discharge and prolonged length of stay in hospitals are arecurrent problem that leads to excessive costs and augmented ratesof complications among the patients (Barach et al., 2015). Some ofthe leading causes of delays and extended length of stay includefinancial issues, the delayed decision regarding funding from socialservice, family delays, coordination disputes by hospital staff,bureaucratic clearance system and hospital requirement of dischargeconsent among others (Gregory, 2015). Correspondingly, dischargedelays have various consequences such as operational inefficiency,increased the cost of the treatment process and the loss ofreputation by the health institution where the patient was admitted.Some of the solutions that have been raised to eliminate thesechallenges include effective patient planning and automatinginstitution procedures.
PDSA model is a simple but valuable model used for testing andaccelerating quality enhancement (Graban, 2016). When the researchteam sets the objectives, institute the participant`s membership anddevelop interventions to determine the possibility of change leadingto improvement, Plan-Do-Study-Act is put into use to examine thechange in real life situation. PDSA comprises of planning, trying,observing outcomes and acting on these findings (HQIP, 2015). Themodel is significant in that it enable the medical team to plansufficiently for their selected innovation meant to improve servicedelivery in health care. The model allows the health care team torectify their novel innovation until the approval rate reaches ninetypercent because testing is done locally and in small scale (Spath,2013). Moreover, it develops confidence build up because theinvention has been tested to ensure that significant resources arenot invested into unworkable change.
Planning requires hospital department inaugurate a team constitutingof discharge coordinators consisting of physicians and nurses toobserve and monitor the patients from the moment they are admitted.These teams will be responsible for calculating the approximate dateof discharge and coming up with suitable arrangements before theactual date of discharge to allow appropriate transition (Barach etal., 2015). The team will also make the necessary arrangements tofacilitate transport for the patients to ensure that unexpectedprocesses do not hinder the process. The reason for the anticipatedoutcome is to have the patients expected timeline for dischargereduced. Practical agreements will also be made on the actual datathat will be collected during the process as well as the individualinvolved in the collection (Gregory, 2015). The required time frameof the entire process will also be agreed because the successes ofthe whole process depend on effective planning.
The team of nurses and physicians will be positioned for respectiveplaces such as reception, pharmacy, surgical wards and other relevantareas (HQIP, 2015). The patients are prepared appropriately such thatthey can quickly move from one serving point to the other.Adjustments are implemented, accurate measurements are carried out,and all the required data is collected for analysis (Graban, 2016).It is significant to allocate adequate time to the activities in thisstage especially if there are more than a single change that had beencarried out. The team will liaise with discharging nurses to lay outthe plan for interdepartmental communication systems regardingdischarge procedures and practices and the necessary notificationsystems as required by the institution and recommended by Gregory(2015). Care should be taken such that all the patients acquire thenecessary instructions and that they provide all the requiredinformation. For instance, contact details are significant becausethey will be required to give feedback on the service offered and theview on the significance of the changes that has been instituted.
The information gathered will be subjected to complete scrutiny, andappropriate comparisons will be made between this process and otheractivities that are taking place in the institution which are notrelated to the real change (Spath, 2013). Patients feedback and otherrelevant information are obtained and analyzed. The information willbe essential in the decision-making process because patients are theprimary beneficiaries of the change being implemented. This stageconstitutes comprehensive studies and precise analysis of the entireprocess to establish the most relevant facts that have been learnedfrom the change that has been implemented (Feigal et al., 2014). Theinformation that has been collected from this stage is significantbecause it is used to determine the level success or failure of theentire process. In this juncture, the team gathers together, and eachgives an account of their experiences that they have collected fromthe process.
Acting is one of the most significant stages in the process ofaccelerating quality enhancement because critical decisions are madeat this stage (Barach et al., 2015). The change can either be adoptedor rejected. Upon rejection, more original arrangements to come upwith something new altogether are made. Ninety percent of all theparticipants in this process must give consent for the process to beconsidered viable. This decision is so significant that it is used bythe institution decision making the body to establish the viabilityand practicability of the change process. Nurses, physician, anddepartmental leaders are not restricted by the change and especiallyif it is not viable (Feigal et al., 2014). Consequently, they are atliberty to adopt other practicable modifications and innovations aslong term goals, because they are at the center of decision-making asfar as the provision of quality and affordable health care isconcerned.
Delayed discharge and prolonged length of stay in hospitals are arecurrent problem that leads to excessive costs and augmented ratesof complications among the patients. Changes in health care aresignificant to ensure that services provided match the needs of thecontemporary issues in health care. Changes implemented in the healthcare sector ought to be sustainable in that it reflects the needs ofthe patient for it to be supported. Accordingly, there is the needfor an efficient model that can be used to not only test butaccelerate quality enhancement. Plan-Do-Study-Act (PDSA) cycle can beused to verify the viability of changes meant to eradicate delays indischarge and reduce the length of stay in hospitals. The modelentails four steps that include planning, doing, studying andacting.
Contemporary healthcare facilities have been witnessing consistentdelays in discharging patients. Scholars associate the delay withhuge requirements in the clearance process (Coffey, Leahy-Warren,Savage, Hegarty, & Cornally, 2016). Besides, poor coordinationamong the involved departments and medical professionals is a majorcause of the delay. The delays have regrettable implications to thehealth treatment and management cost and operational efficiency.Therefore, the understanding of the causes and implications ofdischarge delays can support the identification of reliable andsustainable means to mitigate the problem.
Resources to support change in practice
The elimination of the discharge delays requires additional human andcapital resources. Therefore, intensive literature review andscientific research are significant in facilitating theidentification of reliable resources to address the problem. Modernhealthcare facilities need to adopt effective models, systems, andinterventions to eliminate possible delays in discharging patients(Lenzi, Mongardi, Rucci, Di Ruscio, Vizioli Randazzo and Fantini,2014). The adoption of an integrated system can support teamwork andintegration among all essential facets of the hospital.
The adoption of a multidisciplinary approach can also help to improvethe assessment, diagnosis, and treatment process. The approach canhelp to reduce the period a patient stays in the healthcare facility.Besides, the adoption of reliable intervention plan can facilitatenavigation transition, power transition, and bridge of the existinginterventions. Therefore, the adoption of reliable policies can beproductive in facilitating the reduction of the discharge delays.
The recruitment of an adequate number of professionals can alsoenhance the quick service delivery during the discharge process.Teamwork between patients and health professionals can enhance theimprovement of the time required to discharge patients. The adoptionof effective billing system can enhance the elimination of possibledischarge delays. Other essential resources that can support theelimination of discharge delays include electronic medical and chartrecords, improved care coordination plan, the adoption of effectivebed management plan, and the provision of discharge medicationrecords (Allen, Zellmer, Knoer, Phelps, Marvin, Pulvermacher andShane, 2017).
The purpose of the study is to identify effective means to eliminatedischarge delays in healthcare facilities. Therefore, the study hasimplications for health professionals, leaders, patients, and familymembers. The study indicates that delays in the discharge processhave been a major management problem. Scholars associate the setbackswith the lack of coordination among medical staffs. The huge numberof medical requirements also complicates the process of dischargingpatients from hospitals. The problem has negative implications forpatients and hospital operations and management processes. However,health experts have identified various means and resources that cansupport the reduction of delays in discharging patients. The adoptionof sustainable intervention measures, policies, models, and systemscan largely help to address the problem. Precisely, the use ofintegrated systems, individualized care, interdisciplinarycollaboration, and management, and hospital discharge support canimprove the process of discharging patients. The Plan-Do-Study-Actcan help to deal with the discharge problems in the modern healthcarefacilities. The Plan-Do-Study-Act (PDSA) model can assist to testbenefits and setbacks of the existing intervention measures. Theadoption of reliable coordination plans also has immediate benefitsto the improvement of time required to discharge patients inhealthcare facilities.
The research findings affirm that delayed discharge is a recurrentproblem that has regrettable impacts on patients and the entirehealthcare system. The problem has led to operational problems andthe increase in treatment cost. Therefore, health professionals andother involved leaders need to adopt integrative plans to mitigatethe problem. Changes in the healthcare operations and systems canhelp to address the delay challenges. Automating hospital processesrequires hospitals to procure system that are centralized, and can beaccessed by all in the hospital (Allen et al., 2017). This enhancescoordination among the medical staff and improve communication. Thesystem will enable a quick clearance of discharged patients from therelevant departments as well as improve hospital efficiency.Improving the management system of the hospital ensure a smooth flowof patient in and out of the hospital (Hall et al., 2013). Once apatient is discharged, the information should be passed on to theadmission department notifying them of an unoccupied bed, hencereducing admission time for patients. Planning for patients duringadmission all through to discharge can also reduce discharge delays(Page et al, 2016). The adoption of reliable evaluation plans canassist to examine benefits and setbacks of the identified mitigationmeasures.
Acton, A. Q. (2013). Issues in Nursing Research, Training andPractice: 2013 Edition. Scholarly Editions Publishers.
Allen, S. J., Zellmer, W. A., Knoer, S. J., Phelps, P. K., Marvin, K.C., Pulvermacher, A., & Shane, R. (2017). ASHP FoundationPharmacy Forecast 2017: Strategic Planning Advice for PharmacyDepartments in Hospitals and Health Systems. American Journal ofHealth-System Pharmacy, 74(2), 27s-53.
Barach, P., Jacobs, J. P., Lipshultz, S. E., & Laussen, P. C.(2015). Quality Improvement and Patient Safety. Pediatric andCongenital Cardiac Care: Volume 1: London: Spring Publishers.
Challis, D., Hughes, J., Xie, C., & Jolley, D. (2014). Anexamination of factors influencing delayed discharge of older peoplefrom hospital. International Journal of Geriatric Psychiatry, 29(2),160-168.
Clarke, A. & Tinsley, P. (2012). Completed consultant episodesincrease, but hospital discharges decrease. British Medical Journal,304(6832), 987-987.
Coffey, A., Leahy-Warren, P., Savage, E., Hegarty, J., &Cornally, N. (2016). A Systematic Literature Review On TacklingDelayed Discharges in Acute Hospitals Inclusive of Hospital (Re)Admission Avoidance. University College Cork, Ireland.
Erdogan, E., Robinson, D., Blake, V., & Johari, V. (2013). TestUtilization Review: Do Delays in Laboratory Results Contribute toDelays in Discharge? A Retrospective Analysis of 102 Discharges FromNonacute Medical Floors at an Academic Hospital. American Journal OfClinical Pathology, 140(Suppl 1), A074-A074.
Feigal, J., Park, B., Bramante, C., Nordgaard, C., Menk, J., &Song, J. (2014). Homelessness and discharge delays from an urbansafety net hospital. Public Health, 128(11), 1033-1035.
Graban, M. (2016). Lean hospitals: Improving quality, patient safety,and employee engagement. CRC press.
Gregory, J. (2015). Staff faces conflicting pressures as they dealwith discharge delays. Nursing Standard, 29(26), 9-9.http://dx.doi.org/10.7748/ns.29.26.9.s7.
Hall, R., Belson, D., Murali, P., & Dessouky, M. (2013). Modelingpatient flows through the health care system. In Patient Flow (pp.3-42). Springer US.
Healthcare Quality Improvement Partnership (HQIP). (2015). A Guide toQuality Improvement Methods. Healthcare Quality ImprovementPartnership Publishers.
Institute for Health Improvement. (2017). Science for Improvement:Testing Changes. Retrieved fromhttp://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspxon March 16, 2017.
Joseph, R., Brown-Manhertz, S., Santomassino, M., & Singleton, J.(2014). The effectiveness of the structured interdisciplinarycollaboration for the adult home hospice patients on the patientsatisfaction and the hospital admissions and readmission: asystematic review protocol. Joanna Briggs Institute Database Of theSystematic Reviews And the Implementation Reports, 12(7), 148-163.
Lenzi, J., Mongardi, M., Rucci, P., Di Ruscio, E., Vizioli, M.,Randazzo, C., & Fantini, M. P. (2014). Sociodemographic, clinicaland organizational factors associated with delayed hospitaldischarges: a cross-sectional study. BioMed Central Health ServicesResearch, 14(1), 128.
Marvin, V., Kuo, S., & Linnard, D. (2013). DSL-007 Does PharmacyContribute to Delays in Hospital Discharge? European Journal OfHospital Pharmacy, 20(Suppl 1), A89.3-A90.
Page, J. S., Lederman, L., Kelly, J., Barry, M. M., & James, T.A. (2016). Teams and teamwork in cancer care delivery: Shared mentalmodels to improve planning for discharge and coordination offollow-up care. Journal of Oncology Practice, 12(11), 1053-1058.
Spath, P. (2013). Introduction to healthcare quality management (2nded.). Chicago, IL: Health Administration Press.
No related posts.