Quality Improvement Initiative Increasing Early Discharges From an Acute Care Cardiology Unit for Cardiac Surgery and Cardiology Patients–Associated With Reduced Hospital Length of Stay

Abstract

Introduction: Discharging patients from the acute care setting is complex and requires orchestration of many clinical and technical processes. Focusing on timely discharges improves throughput by off-loading ICUs and coordinating safe outpatient transitions. Our data review demonstrated most discharges occurred later in the day. We sought to improve our discharge times for cardiology and cardiovascular surgery (CVS) patients in our 26-bed inpatient acute care cardiology unit (ACCU). We aimed to increase the number of discharges between 6 am and 12 pm for cardiology and CVS patients on ACCU from 5 to 10 patients per month over 6 months and sustain. Methods: We performed a simplified Failure Mode Effect Analysis on the discharge process and identified improvement opportunities. Our key drivers centered around education, documentation, and planning. Our interventions included: staff education, communication of discharge expectations, daily quality board rounds, hospital-wide collaboration emphasizing conditional discharges, and hospital information technology (IT) improvements. We utilized statistical process control charts to analyze the data. Results: Discharges between 6 am, and 12 pm increased from a baseline of 5 (8%) to 12 (18%) patients per month with a centerline shift. Our process measures demonstrated appropriate conditional discharge usage linked to earlier discharges. Upgrades to our EMR, documentation further increased our timely discharges. Our efforts resulted in a 22% reduction in hospital length of stay from 11.2 to 8.7 days without increased readmission rates suggesting that improved efficiency did not impact care quality. Conclusion: We successfully show how multidisciplinary collaboration and systems-based improvement can increase the number of safe, early discharges.

A Quality Improvement Initiative to Improve Pediatric Discharge Medication Safety and Efficiency

“…The involvement of APPs in ACCUs has been shown to improve the discharge process and patient experience, leading to shorter postoperative lengths of stay than expected. 20,21 The devoted team and unified approach suggest the importance of consistency and standardization for improving care. 22,23 The absence of MAP remains a significant contributor to medication mismatches beyond discharge.…”

“…20,21 The devoted team and unified approach suggest the importance of consistency and standardization for improving care. 22,23…”

Communicating Patient Discharge Readiness

“…staff to discharge patients quickly and safely from the hospital. Health information technology (HIT) solutions can help solve patient flow problems, including identifying criteria for discharging patients when they are clinically ready to discharge, [1][2][3] coordinating and communicating about patient discharge readiness, [4][5][6] and helping make informed decisions about capacity allowing real-time capacity management. 7,8 We piloted a Discharge Today tool designed to facilitate real-time communication across clinicians and health care staff about patient discharge readiness with the goal of improving the efficiency of patient discharge.…”

“…The progression of patients through a hospital from admission to discharge (ie, patient flow) can be slowed by delays in patient discharge, increasing pressure on health care staff to discharge patients quickly and safely from the hospital. Health information technology (HIT) solutions can help solve patient flow problems, including identifying criteria for discharging patients when they are clinically ready to discharge,1-3 coordinating and communicating about patient discharge readiness,4-6 and helping make informed decisions about capacity allowing real-time capacity management 7,8…”