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Abstract
Background Optimising system-level hospital flow improves patient care, patient/caregiver experience and provider satisfaction by allowing patients to receive timely and appropriate care. In prior work, our team implemented a novel discharge process in hospital medicine patients focusing on diagnosis-specific medical discharge goals and successfully increased the percentage of patients discharged within 2 hours of meeting those goals from 42% to 80%.
Objectives Increase the percentage of acute care patients, hospital-wide, whose discharge process centres around medical goals from 25% to 90%.
Methods Key drivers included staff engagement in discharge preparedness, implementation package availability, and data transparency. Our primary measure was the percentage of acute care patients whose discharge medical goals were documented, condition-specific, and continuously updated. We also tracked the progress of individual medical and surgical teams throughout the implementation timeline (Figure 1). Our secondary outcome measure was the percentage of patients discharged within 2 hours of meeting their medical discharge goals.
Results The percentage of patients whose discharge process included medical goals increased from 25% to 76% in 3 years. The progress of individual teams is displayed in Figure 2. For patients who followed the process, the percentage of patients discharged within 2 hours of meeting medical discharge goals increased from 42% to 85% (Figure 3); however, this overestimates success, as patients are only included in this measure if all parts of the process are followed.
Conclusions We successfully spread discharge efficiency based upon medical goals to a majority of hospitalised acute care patients; however, we continue to identify improvement opportunities with process adherence.
Implementation timeline
Specific team progress
Percentage of patients who are discharged within 2 hours of meeting medical goals*.
*Patient are only included in this measure if they have physician orders that document their medical goals for discharge and if the bedside nurse documents a time when they have met their medical goals