Executive Summary: Eliminating Discharge Delays
Executive Summary: Eliminating Discharge Delays
Bed capacity has emerged as a critical issue in hospital quality management with evidence indicating that inefficient discharges contribute to slow care and patient flow while further increasing costs. Changes made to the prospective payment system by Medicare in recent years have increased pressure on hospitals to cut costs through, among other ways, reducing patient length of stay (LOS) (El-Eid et al., 2015).
‘Eliminating discharge delays’ is a quality management project that focuses on reducing patient length of stay and as such improving hospital throughput. The project entails implementation of several strategies that collectively improve the efficiency with which patients are discharged at the hospital. Among these strategies include making the appropriate resources for patient discharge available. Past studies have indicated that safe and timely discharge of patients is dependent on the ability of health providers to respond rightly to patients’ clinical, social, and financial needs (Maloney et al., 2007). Indeed, allocation of extra resources within a health facility enables acute units to facilitate late discharges and this in turn ensures that patients do not spend extra days in the hospital. Extra resources may also be used to expand a hospital’s social work discharge planning support. Overall, availability of extra resources increases the efficiency with which patients’ discharge needs are addressed.
Starting discharge planning at the admission stage is another important strategy through which the project seeks to reduce patient length of stay. In regard to this strategy, it is important to acknowledge that LOS is best managed when the patient’s journey from admission to discharge is planned for well in advance (Gray, 2016). In addition to planning the patient care process, this strategy requires that the hospital looks at planning in advance the discharge process. This involves, among other activities, establishing an estimated date of discharge based on the patient’s presenting conditions.
Another significant strategy involved in this project entails implementing multidisciplinary care coordination rounds. This approach allows for providers to identify patients at high risk of prolonged LOS and this in turn enables further and close assessment of such patients (Arya, 2015). In addition to establishing the level of risk of prolonged LOS in patients, this strategy involves identification of barriers to discharge and patients that may have unique support needs after discharge. When employing this strategy, a collaborative approach among physicians is particularly important. Communication and coordination across the care continuum serves to prevent readmissions.
Target Population
The program targets senior inpatients and as such will be implemented at the senior care units and the acute care units. Studies have indicated that senior inpatients are at an increased risk of prolonged LOS as they are less resilient during a hospital stint. For this population, prolonged LOS has been associated with mental and physical deterioration that increases the risk of a hospital-inquired infection (Costa et al., 2012). The choice of this target population is, therefore, based on the observation that hospitalization of the elderly can have more harm than good on the patient especially when the length of stay is prolonged. Considering the many duties that hospital staff has, prolonged hospitalization of the elderly may mean that such patients lack adequate attention.
Benefits of the Program
The above program will have several benefits on the target population. One of the most important benefits is the reduced risk of hospital-acquired infections (HAIs) which are common among senior inpatients. While HAIs can affect anyone regardless of age, sex, and gender, these infections tend to have a greater impact on the elderly population compared to other patient populations. Eliminating discharge delays will, therefore, go a long way in reducing the risk of these infections since elderly patients will have to spend less time in the hospital.
Another benefit of this program is that it will impact positively on hospital budget by cutting the additional costs associated with treatment of HAIs. According to the Centers for Disease Control and Prevention (CDC), approximately 2 million patients suffer from HAIs every year while nearly 10,000 of them succumb to the conditions acquired. Despite the fact that most of the medical errors associated with HACs are preventable, the annual additional cost of HACs has been quoted as up to $4.5 billion. By focusing on prevention of HAIs through elimination of discharge delays, the program will surely have a positive financial impact on the hospital.
Budget Justification
Considering that one of the primary benefits of the program is reducing operational costs for the hospital, it is important that the budget for its implementation be moderate. In total, the program is estimated to cost $105,000. This cost is justified by the important benefits the program will have on the hospital’s operations once implementation is completed. The proposed budget for the program is as indicated below;
Program Evaluation
Implementation of the program will take place in phases and this will allow for easy evaluation. The first phase will involve nursing staff training where nurses will be educated on the fundamentals of the project. Upon completion of this phase, the project will move on to the next phase which will involve acquiring the appropriate resources for efficient patient discharge. The project implementation team will be tasked with developing a list of all the resources that the hospital needs in order to ensure efficient patient discharge. The nurse executive at the hospital will evaluate and approve the list before these resources are acquired. The next phase of the project will involve streamlining the patient discharge process. Implementation of this phase will involve nurse leaders across the targeted inpatient units. The last phase which will be implementation of multidisciplinary care coordination rounds will involve all nurses at the hospital.
Overall, the program will be implemented in such a way that progression to the next phase will only commence upon successful implementation of the previous phase. Evaluation will mostly focus on identifying the program’s shortcomings and refining such areas. The team leader in charge of the project will set the timeline for the implementation of each phase as well as the milestone for conducting effective analysis and evaluation. After full implementation, the program will be evaluated every three months to ensure everything is running as initially planned.
Feedback
Do you believe the proposal would be approved if formally proposed?
I think the proposal would be approved as it seeks to solve a serious issue facing most hospitals. With the changes made to the Medicare program recently, most hospitals are under pressure to prevent hospital acquired infections and I believe the proposal offers a great solution to this problem.
What are some strengths and weaknesses of the proposal?
One of the most significant strengths of the proposal is that it offers a solution most hospitals are currently facing and this increases its chances for approval. It can also be noted that the budget for the proposal’s implementation is relatively modest. The proposal’s only significant weakness is probably the lack of adequate information on how the actual implementation process will be carried out.
References
Arya, D. K. (2015). Is it Time to Stop Writing Discharge Summaries?. Asia Pacific Journal Of Health Management, 10(2), 68-73.
Costa, A. P., Poss, J. W., Peirce, T., & Hirdes, J. P. (2012). Acute care in-patients with long-term delayed-discharge: evidence from a Canadian health region. BMC Health Services Research, 12(1), 172-181.
El-Eid, G., Kaddoum, R., Tamim, H., & Hitti, E. (2015). Improving Hospital Discharge Time. Medicine (Baltimore), 94(12): e633.
Gray, E. A. (2016). Discharge by 11:00 a.m.: The Significance of Discharge Planning. MEDSURG Nursing, 25(6), 381-384.
Maloney, C., Wolfe, D., Gesteland, P., Hales, J., & Nkoy, F. (2007). A Tool for Improving Patient Discharge Process and Hospital Communication Practices: the Patient Tracker. AMIA Annual Symposiums Proceedings, 2007: 493-497.
