Dedicated Discharge Teams Improve Throughput in Hospitals Experiencing Crisis-Level Shortage of Beds

Background/significance: Hospitals functioning near capacity are a prevalent problem affecting patient flow and hospital operations throughout the United States. During the pandemic, hospitals have been overwhelmed with a surge in patients requiring hospital beds. This places a significant strain on the health care infrastructure to safely care for patients at the local and state level. To mitigate this problem, one unit at UCD Health identified barriers to discharges and created initiatives aimed to improve patient discharges. The discharge reception area (DRA) is a dedicated resource assisting with transitions of care but has been underutilized. The DRA operates to facilitate discharges and is instrumental in improving hospital throughput by addressing discharge needs and promptly discharging patients.

Purpose: This project aims to improve D14’s utilization of the DRA to facilitate throughput and meet the hospital goal of discharging patients by 2pm.

Methods/implementation: Utilizing the A3 qualitative improvement process to guide the discharge by 2pm initiative, a root cause analysis (RCA) was completed to identify potential barriers to discharge. Identified barriers were then examined for areas of improvement: patient transportation, belongings, medications, patient/family training, and medical equipment. Many barriers identified in the RCA can be addressed by the DRA. We created an action plan to educate staff about the DRA and maximize use of resources offered by the DRA. We then formulated a pre-test assessment to gauge staff knowledge about the DRA from January 23 - February 5. Our intervention aimed to improve nurses’ knowledge of DRA by discussing resources offered by DRA during our daily pre-shift huddle from February 6-19. We then completed a post-test to reassess nurses’ knowledge of DRA from February 25 - March 12.

Results/evaluation/outcomes: DRA education pre-test (n=24) and post-test (n=25) participation among staff was similar. In 6 out of the 10 survey questions, there was an increase in score post-education. We saw an increase in D14’s utilization of DRA: February 23.76%, March 27.63%, and April 25.23%. D14 also improved in the hospital goal of discharging patients by 2pm: February 40%, March 43%, and April 46%. Percentages analyzed by service to discharge patients by 2pm on D14 are as follows: orthopedics: 45.6%, neurosurgery: 36.4%, surgery: 32.3%, and medicine: 24.3%. 3.12 hours is the average time it took to discharge a patient once discharge orders were placed.

Conclusion/implications: Education about DRA enhanced D14’s DRA utilization and improved or maintained D14’s discharge by 2pm percentages. Having a dedicated discharge resource team to help with discharges and transitions of care has improved hospital throughput at UCD Health. Further studies should focus on hospital-wide impact with utilization of DRA.

References
1. French G, Hulse M, Nguyen D, et al. Impact of Hospital Strain on Excess Deaths During the COVID-19 Pandemic — United States, July 2020–July 2021. MMWR Morb Mortal Wkly Rep 2021;70:1613–1616. DOI: http://dx.doi.org/10.15585/mmwr.mm7046a5external icon.