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201409261

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UWHC,UWMF,

Nursing,Clinicians,Patient Care,Patient Services,

Departments & Programs,Programs and Initiatives

Discharge Collaborative

Discharge Collaborative - Departments & Programs, Programs and Initiatives

Focus

The Discharge Collaborative is an organization-wide initiative to improve the discharge process through the implementation of a standard workflow. The first stage of the Discharge Collaborative will focus on documenting an Anticipated Discharge Date for every patient within 24 hours of admission, discussing and updating the Anticipated Discharge Date each day during IMOC rounds, and documenting a Confirmed Discharge Date and Time the day before or day of discharge.

FAQ

What is the Discharge Collaborative and what are its goals?

From data regarding patient and staff experience we know the discharge process is inefficient, not standardized and leads to dissatisfaction among patients, family members, faculty, and staff. As a result, we have an opportunity to remove time from the discharge process for increased patient throughput; improve patient satisfaction; improve patient education opportunities; identify and document the planned date and time every discharge; and clarify roles and responsibilities of members of the patient care team.

The Discharge Collaborative’s goals are as follows:

What measures will be tracked?

Please refer to the following:

Metrics

Goal

Percent of Patients with an Anticipated Discharge Date within 48 hours of Admission

90%

Percent of Patients with any Anticipated Discharge Date

90%

Percent of Patients with a Confirmed Discharge Date and Time

100%

Average Difference in Confirmed Discharge Time Compared to Actual Discharge Time

≤ 30 minutes

Average Time of Day Patient Discharge

2 hrs less than current state

Percent of Patients Going to a SNF who are Discharged by Noon

90%

Speed of Discharge Process After You Were Told You Could Go Home?

90%

 

What is the Anticipated Discharge Date?

The Anticipated Discharge Date is an estimate of the hospital length of stay determined within the first 48 hours following admission. This will be reviewed with the patient on a daily basis and is expected to change. It will be documented on the patient’s white board and in the Discharge Status Board.

What are the Confirmed Discharge Date and Time?

The Confirmed Discharge Date and Time are determined the day before discharge or day of discharge and the time is agreed upon by the patient, family/caregivers and the medical team. It will be documented on the patient’s white board and in the Discharge Status Board.

What happens with patients here less than 48 hours?

The Anticipated Discharge Date will not be needed; only Confirmed Discharge Date and Time should be used.

Will patient satisfaction decrease if we do not meet the Confirmed Discharge Date and Time?

A UW Hospital pilot demonstrated that it is possible to discharge patients within 30 minutes of their Confirmed Discharge Date and Time. Additionally, hospitals across the country have already implemented similar processes with excellent results. We also know patients are already dissatisfied with the discharge process. Communicating and setting expectations about their Anticipated and Confirmed Discharge Dates and Time will help improve the patient, family member, staff, and faculty experience. One patient said, “I think it would be easier for family/caretakers to have a specific time when discharge instructions will be given and perhaps a reminder of how much time that might take.”

Will patient satisfaction decrease if the Anticipated Date is updated daily?

It will be important to set expectations with patients that the anticipated discharge is just that—anticipated. Based on the progression of the patient’s illness and other clinical and social factors, the Anticipated Discharge Date may be adjusted. Additionally, it will be important to continue open and honest communication with patients about their Anticipated Discharge Date and the goals needing to be met for a successful discharge. Feedback from patients and families indicate that they want this. One patient explained that "Most patients do not have an understanding of how long hospitalizations are for different conditions so it is helpful to give them an anticipated discharge as soon after admission as possible with the understanding that their condition will determine a time certain for discharge."

Our patients are too complicated for us to know when they will be discharged.

There may be instances where the patient’s complex condition makes the prediction of a discharge date nearly impossible. In these circumstances, give your best estimate at admission, then review and update daily as the patient’s condition changes. As a provider, you can say what you know for sure and acknowledge what you don’t. For example, you could say “Ms. Jones, I don’t know exactly how long you will be in the hospital because you have X condition, we have to do some tests/give you therapy/treatment, and depending what the tests show and how the treatment works, we can’t say for sure how long you will be here, but at this point I anticipate you will be here for at least 7 days. We will evaluate your status every day and give you updates to let you know how much longer beyond the 7 days we anticipate you will be here.”

What happens if there are two discharges scheduled at the same time for the same nurse?

One of the discharges will get rescheduled for 30 minutes later. In the UW Hospital pilot this was rarely an issue.

Will there be problems with insurance if a patient discharges later than their Anticipated Discharge Date?

No, the Anticipated Discharge Date is an ongoing evaluation and insurance companies will not be tracking this data.

Resources

Feedback Form

Discharge Collaborative Feedback Form

General 

Training

In-Room Display of Day and Time Patient Is Anticipated to Leave Hospital: A “Discharge Appointment”