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Fast In Fast Out: Improving Patient Discharge and Increasing Throughput

Hospital emergency departments are fast-paced environments where physicians and nurses race against time to deliver care to patients. To be effective, hospitals rely on metrics to assess the performance of their emergency departments. One such metric is discharge time which is the time it takes for a patient to be seen and discharged.

The discharge process is multifaceted and can involve various medical personnel such as physicians, nurses, radiologists, cleaners, administrative staff, etc. An emergency department with a short discharge time is indicative of a high degree of efficiency and coordination.

The process of efficient patient discharge can be explained by the example of a relay race. To win a race, the baton must be seamlessly passed from runner to runner or in this case, the healthcare providers. For winning this race, communication is key. Similarly, one of the best ways to turbocharge the patient discharge process is to improve communication and awareness amongst the various personnel involved, i.e., passing the baton. This can be done in three ways:

  1. Sharing discharge related information
  2. Early Identification of Potential Discharges
  3. Prioritization of patients that are being discharged

Sharing Discharge Related Information

In an emergency department where medical staff members are highly specialized, silos could form amongst the various functional groups in the absence of information sharing. This is especially problematic because the lack of visibility of how work in one area flows into other areas can grind the discharge process to a halt. One of the ways to alleviate this is to circulate the discharge plan. Doing so will allow staff members to anticipate discharges and prepare ahead of time. For example, if a physician ordered a test prior to discharging a patient, case managers and social workers can begin the process of making discharge arrangements while the tests are being conducted. This way, the two processes can occur concurrently. If the discharge plan is not shared, the case managers and social workers will likely find out about the discharge once the patient’s tests are completed which adds extra time to the process.

Early Identification of Potential Discharges

Patients should not have to wait until daily rounds to be identified for discharge. If a patient is fit for discharge at 8 am and daily rounds do not happen until 10 am, then we just lost 2 hours in the discharge process. By discharging patients earlier in the day, rooms can be vacated which increases capacity to admit more patients and improves throughput.

Prioritizing Patients That Are Being Discharged

Patients that are being discharged should be prioritized throughout the emergency department. When the physician orders additional tests for a patient, are the lab technicians aware that the orders are for a patient waiting to be discharged? Improving communication, giving increased visibility to the technicians, and streamlining the process will allow the technicians to prioritize the orders for discharge patients by moving them up the work queue.

An efficient patient discharge process is indicative of a coordinated emergency department. By combining active management with the three ways of improving patient discharge, emergency departments can increase throughput without sacrificing the quality of care which would increase patient satisfaction and reduce the number of patients that leave without treatment.

The author of this blog, George Xu is a Senior Consultant and Trindent Consulting.