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Journal of Healthcare Engineering 2018Short discharge time from hospitals increases both bed availability and patients' and families' satisfaction. In this study, the Six Sigma process improvement...
Short discharge time from hospitals increases both bed availability and patients' and families' satisfaction. In this study, the Six Sigma process improvement methodology was applied to reduce patients' discharge time in a cancer treatment hospital. Data on the duration of all activities, from the physician signing the discharge form to the patient leaving the treatment room, were collected through patient shadowing. These data were analyzed using detailed process maps and cause-and-effect diagrams. Fragmented and unstandardized processes and procedures and a lack of communication among the stakeholders were among the leading causes of long discharge times. Categorizing patients by their needs enabled better design of the discharge processes. Discrete event simulation was utilized as a decision support tool to test the effect of the improvements under different scenarios. Simplified and standardized processes, improved communications, and system-wide management are among the proposed improvements, which reduced patient discharge time by 54% from 216 minutes. Cultivating the necessary ownership through stakeholder analysis is an essential ingredient of sustainable improvement efforts.
Topics: Efficiency, Organizational; Health Personnel; Humans; Models, Organizational; Patient Discharge; Quality Improvement; Time Factors; Total Quality Management
PubMed: 30034673
DOI: 10.1155/2018/3832151 -
British Journal of Community Nursing Apr 2021Over the past 30 years, the Government has been promoting the transition of care from the acute setting to the community setting. Within the community setting, district... (Review)
Review
Over the past 30 years, the Government has been promoting the transition of care from the acute setting to the community setting. Within the community setting, district nurses are described in the latest reports as endorsers of the care close to home. However, with the surge in hospital discharge, the district nursing workforce is faced with further pressure to cope with the drive to move care into the community. The purpose of this extended literature review (ELR) was to deconstruct the available data on the challenges and hurdles experienced by district nurses to manage hospital discharge. On reviewing the selected data, it was found that fragmented communication between secondary and primary sectors poses problems for effective care in the community. Additionally, the lack of understanding of the district nursing service and its remits creates obstacles for effective hospital discharge. Some practical solutions to resolve these problems are proposed.
Topics: Communication; Humans; Nurses, Community Health; Patient Discharge
PubMed: 33797967
DOI: 10.12968/bjcn.2021.26.4.184 -
Peritoneal Dialysis International :... May 2014
Topics: Disease Management; Humans; Hyponatremia; Patient Discharge
PubMed: 24863872
DOI: 10.3747/pdi.2014.00114 -
Critical Care Medicine May 2014
Topics: Bias; Hospital Mortality; Humans; Intensive Care Units; Patient Discharge; Quality of Health Care
PubMed: 24736337
DOI: 10.1097/CCM.0000000000000193 -
Journal of Pediatric Nursing Oct 1998Early discharge from the NICU has created much controversy and concern among health care professions and parents. It sparked legislative discussions at the state and... (Review)
Review
Early discharge from the NICU has created much controversy and concern among health care professions and parents. It sparked legislative discussions at the state and federal levels spawned from the legislative mandates for mother/baby discharges of not less than 48 hour for uncomplicated vaginal deliveries. However, unlike the term, healthy newborn and the mother, there are no uniform criteria for NICU discharges. Much of the health care once given in the confines of the NICU has moved into the home. Parents are being expected to provide "high-tech" care with little or no professional help. This article discusses the rationale for the health care delivery changes and the need for guidelines for safe, early NICU discharges. Developmental care and community resources within the context of early intervention programs are discussed and individualized family service plans explained.
Topics: Aftercare; Home Care Services; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Length of Stay; Nursing Assessment; Parents; Patient Care Planning; Patient Discharge; Practice Guidelines as Topic; United States
PubMed: 9798365
DOI: 10.1016/S0882-5963(98)80015-8 -
Alberta RNFor over two decades, capacity issues within Edmonton hospitals have existed. Crowded emergency departments with numerous patients waiting for admission into inpatient...
For over two decades, capacity issues within Edmonton hospitals have existed. Crowded emergency departments with numerous patients waiting for admission into inpatient beds has made patient flow a topic at all administrative levels for all services. From a systems perspective, most strategies have simply displaced the problem from one part of the system to another. If we are going to make a true difference, a "big picture" systems approach is required and traditional ways of doing business need to be challenged. Like any discussion around flow, inputs and outputs must have a level of equilibrium and equality, or bottlenecks will occur. Although patient flow has been a huge focus across the continuum of care, discharge planning traditionally has remained with the provider where the patient currently is, as opposed to where the team feels the patient's end destination will be.
Topics: Hospitalization; Humans; Patient Admission; Patient Discharge; Rehabilitation Centers
PubMed: 29758140
DOI: No ID Found -
Diseases of the Colon and Rectum Jul 2011
Topics: Colonic Diseases; Health Care Costs; Humans; Patient Discharge; United States
PubMed: 21654240
DOI: 10.1007/DCR.0b013e31821485ab -
Australian Health Review : a... Sep 2013To understand what impact hospital inpatient occupancy levels have on patient throughput by analysing one hospital's occupancy levels and the rate of patient discharge.
OBJECTIVE
To understand what impact hospital inpatient occupancy levels have on patient throughput by analysing one hospital's occupancy levels and the rate of patient discharge.
METHODS
A four-stage model was fit to hospital admission and separation data and used to analyse the per-capita separation rate according to the patient load and the impact of hospital over-census actions.
RESULTS
Per-capita separation rates are significantly higher on days when the hospital declares an over-census due to emergency department crowding. Per-capita separation rates are also higher or lower on days with 8-10% higher or lower patient loads, respectively, but the response is not nearly as strong as the response to an over-census declaration, and is limited to patients with an elapsed stay of 10 days or more. Within the medical division there is an increase in per-capita separation rates on over-census days, but no significant difference in per-capita release rates for different patient loads. Within the surgical division there is no significant difference in per-capita separation rates on over-census days compared with other days, but the patient load does make a significant difference.
CONCLUSION
Staff do discharge a greater proportion of long-stay patients when the hospital is experiencing high demand and a lower proportion when occupancy is low, but the reasons driving those changes remains unclear.
Topics: Bed Occupancy; Crowding; Databases, Factual; Emergency Service, Hospital; Hospitals, Teaching; Humans; Models, Statistical; Patient Discharge; Queensland
PubMed: 23837997
DOI: 10.1071/AH12012 -
Journal For Healthcare Quality :... 2017This study aims to determine the proportion of nonacute patients occupying acute care beds and to describe their needs, the appropriate level of alternative care, and...
This study aims to determine the proportion of nonacute patients occupying acute care beds and to describe their needs, the appropriate level of alternative care, and reasons preventing discharge. Data from 952 patients hospitalized in an acute care unit for 30 days were obtained from their medical charts and by consulting with the medical team at two tertiary teaching hospitals. Among them, 333 (35%) were determined nonacute on day 30 of hospitalization. According to the Appropriateness Evaluation Protocol (AEP), 55% had no medical, nursing, or patient needs. Among nonacute patients with AEP needs, 88% were related to nursing/life-support services and 12% related to patient condition factors. Regarding alternative level of care, 186 (56%) were waiting for out-of-hospital resources, of which 36% were waiting for palliative care, 33% for long-term care, 18% for rehabilitation, and 12% for home care. For the remaining 147 (44%) nonacute patients, the alternative resources remained undetermined although acute care was no longer required. Main reasons preventing discharge included unavailability of alternative resources, ongoing assessment to determine appropriate resources, ongoing process with community care, and family/patient education/counseling. Available subacute facilities and community-based care would liberate acute care beds and facilitate their appropriate use.
Topics: Adult; Aged; Aged, 80 and over; Female; Home Care Services; Humans; Long-Term Care; Male; Middle Aged; Needs Assessment; Patient Discharge
PubMed: 28658090
DOI: 10.1111/jhq.12076 -
MedEdPORTAL : the Journal of Teaching... Dec 2018Safe transitions of care are an essential component of safety and quality for the patient community. It is imperative that providers choose appropriate discharge...
INTRODUCTION
Safe transitions of care are an essential component of safety and quality for the patient community. It is imperative that providers choose appropriate discharge settings to reduce avoidable hospital readmissions. Additionally, providers must also ensure that the multifaceted needs of each patient are met with every discharge recommendation. There is often a lack of formal instruction in medical school on the various discharge dispositions, indications for rehab, and clinical indications for each setting. This is problematic for new interns who are tasked with entering discharge orders and relaying critical information between lead physicians and the interprofessional team.
METHODS
A 60-minute workshop with both didactic and experiential components provided medical students with opportunities to gain an overview of discharge dispositions while also exercising critical thinking using case examples. The workshop was part of a 2-week Transition to Residency course at a single institution.
RESULTS
Twenty-two fourth-year medical students participated in the workshop. Following the workshop, 100% of the participants stated that they had learned something new and that they intended to use the content in practice as interns. Subjective responses indicated that workshop content ought to be incorporated earlier in medical training.
DISCUSSION
These results suggest that a 60-minute workshop including didactic instruction as well as experiential and inquiry-based learning can impact medical student knowledge and intent for practice change in regard to providing safe transitions of care for the patient community.
Topics: Clinical Competence; Education; Feedback; Humans; Patient Discharge; Rehabilitation; Students, Medical
PubMed: 30800985
DOI: 10.15766/mep_2374-8265.10785