Discharge on Time ... Every Time
25 July 2013 Last updated:
30 September 2014
Discharge on Time ... Every Time
Zena Wilson and Kathy Gradidge, Nepean Blue Mountains Local Health District
The 'Discharge on time...every time' project at Nepean Hospital aims to improve the flow of patients throughout the hospital, thus improving the overall patient journey by:
- increasing the number of discharges by 10am to 30% hospital wide within a 12 month period
- realigning the mismatch between discharge and admission times within 12 months
- increasing the confidence and satisfaction of patients, carers and staff regarding the discharge date and time within a 12 month period.
The key issues identified are:
- the inability to correctly identify the expected date of discharge
- the lack of planning for discharge
- medical availability to perform the tasks necessary to complete the process
- the ability to provide reliable transport in a timely manner.
A whole of hospital approach is being used to achieve the cultural change required.
Planning and Diagnosis
The project was initially called '10am Checkout'. Following much deliberation and research this was subtly changed project from '10am Checkout' to 'Discharge on time ... every time'. This was a significant step for the project, because it was impossible to discharge all patients by 10am and unnecessary.
The most important objective for Nepean was to realign the mismatch between admissions and discharges, achieve 30% discharges by 10am and improve patient and staff satisfaction in relation to the discharge process.
90 patients and 244 staff members were consulted and have provided valuable comments to help shape this project.
- The patient survey revealed frustrations with not knowing the expected date of discharge.
- 89% of patients had no idea when they were going home
- 27% of staff knew the correct Expected Date of Discharge
Sponsorship and engagement
50-60 people across five groups; medicine, surgery, cancer, aged, and maternity, each with medical, nursing, allied health and the executive staff, attended a diagnostic workshop to review the consultation findings and understand the current discharge process.
Flyers and communiqué for all staff and patients were developed and circulated in an attempt to raise awareness, get people involved and eventually to maintain momentum.
Nepean has an established Patient Flow Executive Team (PFET). This project became part of the standing agenda and still is. This is vital to obtain the cultural change. The PFET enabled the project to reach more key stakeholders, especially in relation to the medical clinicians.
The General Manager and the Executive Medical Director are the project sponsors. They are very influential and have strong leadership qualities throughout the organisation. Their support and leadership is critical to the success of this project.
Discharge on time...every time is discussed and deemed to be important by the most important people in the hospital. This sends very powerful messages.
Developing and Implementing Solutions
The implementation plan extends over the next twelve months and ends in October 2013. The solutions are divided into three phases and are the project is currently working to implement phase two.
- Clinician defined Estimated Date of Dishcarge increased from <10% to 75% February 2013
- Discharge by 10am results in line with projection of 30% within 12 months
- Identifiable shift in discharges between 8am and 10am
- There has been a significant reduction in patient complaints relating to waiting times in the emergency department
Operations Nurse Manager, Nepean Hospital
Nepean Blue Mountains Local Health District
PO Box 63, Penrith NSW 2751
Phone: 02 4734 1599
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