- Patients are more likely to leave the hospital earlier in the day – and complete the discharge process more quickly – when organizations employ a standardized, coordinated discharge planning program headed by a patient navigator, finds a study from the American Journal of Accountable Care.
“In the era of increasing cost constraints, inefficiencies in patient discharge present a major challenge to patient throughput in many health systems,” wrote a team of authors from the Department of General Surgery at Geisinger Medical Center in Washington, DC.
“Inefficient discharge results in over-occupancy, which can prevent the admission and treatment of new patients.”
Hospitals can easily enter a state of “gridlock” when discharges are delayed by even an hour or two, the study explains. When inpatient capacity remains at its limit, ICU patients are unable to move to less intensive care settings.
Emergency departments then become unable to admit new cases, post-anesthesia care units cannot shift their charges to longer-term rooms, and new surgical procedures are often cancelled or delayed due to a lack of space for post-op patients.
Not only does this situation produce the potential for patient safety errors and treatment lapses due to overcrowding, but it can have a negative impact on financial management and patient satisfaction rates.
Previous research indicated that poor notification systems, uncoordinated processes, and unreliable data from electronic health records could all contribute to confusion and delays in patient discharge, the study notes.
A 2015 study from the American Heart Association’s Circulation journal found that discharge summaries are often delayed by days or weeks, and that patients with heart failure often leave the hospital with incomplete records of medication changes, lab test results still pending, and no clear idea of when records of their hospital stay will reach their primary care providers to aid in follow-up care.
While CMS released a proposed rule at the end of 2015 requiring hospitals to implement medication reconciliation, patient education, and standardized post-discharge education and planning activities, many providers are still coming up short.
While some organizations have adopted strategies developed in the hospitality world to ensure that patients check in and out of inpatient beds in the same way as they do in a hotel, Geisinger added the idea of a dedicated patient navigator to oversee the discharge process, provide instructions to patients, and coordinate follow-up care.
The retrospective study examined the discharge experiences of 1005 patients headed for home after elective inpatient colorectal surgical procedures between 2007 and 2014 at a Geisinger tertiary care facility.
The discharge navigation program includes a five-step process, starting with a meeting between the patient navigator and house staff each morning to identify which patients will be ready for discharge that day. The navigator then conducts a medication review, confirms any necessary prescriptions, teaches patients and caregivers about wound care or other needs, and then confirms follow-up appointments.
The strategy produced positive results for both patients and their providers. During the first phase of the program, half of discharge orders were written before 11:00 AM, thirty-percent between 11:00 and 2:00 PM, and the remaining 20 percent were completed after 2:00 in the afternoon.
By the end of the trial, only 9 percent of discharge orders were completed after 2:00 PM. Sixty-five percent were finished by 11:00 in the morning, giving patients a much better chance of getting out the door earlier in the day.
Early completion of paperwork did have a measure effect on exit times, the study found. At the beginning of the study, only 52.5 percent of patients scheduled for discharge were able to leave the hospital by 2:00 PM. After implementation of the navigator program, the number increased to 60.2 percent. The median time of patient discharge moved from 1:45 PM at the start of the program to 1:15 PM by the end.
The patient navigators also shaved half an hour off of the time it took to complete the discharge process.
The authors attribute the success of the program to the fact that a single staff member coordinated patient discharges from beginning to end, adhering to standardized methods for completing the process. The coordinator was able to facilitate communication across the care setting while ensuring that patients received the instructions they need to care for themselves at home.
“The greatest obstacle to timely patient discharge is the lack of a standardized protocol specifically facilitating interdepartmental communication during the discharge process,” the authors concluded.
“The findings of this study demonstrate that a standardized approach to discharge can improve hospital throughput and potentially lead to a reduction in errors and improved overall patient satisfaction. In the future, we plan to continue researching the effectiveness of the discharge navigation program.”