Executive Summary

More than 70% of patients at the University of Wisconsin Hospitals and Clinics are assigned a designated discharge date and time, and the average patient leaves within 28 minutes of the set time.

  • A multidisciplinary discharge collaborative including Patient and Family Advisors (PFAs) developed the initiative after getting feedback from people throughout the hospital, as well as from patients and family members.
  • The anticipated date of discharge is documented in the medical record and written on the communication board in the patient’s room.
  • Ideally, the time is added the day before the discharge.

 

As the result of a hospital-wide initiative to improve the discharge process, more than 70% of patients at the University of Wisconsin Hospital and Clinics have a designated discharge date and time, and on average, patients leave within 28 minutes of the set time.

“When we analyzed our patient satisfaction data, we saw that patient satisfaction with the speed of the discharge process after they were told they could go home hovered around 49%. This level of satisfaction was not nearly what we wanted it to be. Our clear aim was to improve patient satisfaction with discharge by scheduling a set date and time and having patients leave within 30 minutes of that time,” says Ann Malec, MS, RN, NEA-BC, director of medical nursing for the 592-bed medical center.

A multidisciplinary team that included the medical center’s Patient and Family Advisors (PFAs) developed two goals to enhance patients’ discharge experience, Malec says. “First we wanted to keep patients updated with their anticipated discharge date, with the understanding that it’s a moving target. Once the patient was deemed medically ready for discharge, we also wanted to set a specific time for the discharge, ideally the day before the discharge,” Malec says.

The discharge collaborative team included physicians, nurses, case managers, pharmacists, physical therapists, Patient and Family Advisors (PFAs), and representatives from quality, business planning and development. Eventually, the larger group was pared down to approximately 10 people who serve as steering committee members.

It took a year of planning to develop the discharge initiative, Malec says.

“We got feedback from people throughout the hospital. We met with the senior leadership, the quality council, and the executive committee. We went to department meetings and high-level nursing meetings. Our goal was to raise awareness about the discharge collaborative and why improving the discharge process was important. If there was a meeting, we were there,” she says.

The steering committee made rounds on the nursing units and talked to the nurses on the unit about what worked well in the discharge process and where the problems were, Malec says. They also met with patients and family members to find out how to make the discharge experience better.

The medical center’s PFAs were key members of the discharge collaborative team, Malec says. PFAs are lay individuals who have been patients or family members of the patient. They serve on hospital advisory councils and committees and help the staff see processes and practices through the eyes of the patient.

Patients and family members consistently reported that they would like to know the discharge date in advance so they could prepare and have a chance to ask questions before the last day, says Peggy Zimdars, a volunteer Patient Family Advisor who served on the steering committee.

“Patients and family members told me that it would be helpful to get information about their discharge goal early in the stay. When the nurse or doctor says, ‘good news, you can go home today,’ it’s not always such good news for the patient and family because there is a lot to do to get ready at home. Knowing the date earlier ensures a safe and smooth transition home. Patients told me they didn’t mind that the date might be changed, but they did like knowing in advance,” she says.

The committee originally set a goal of identifying a tentative discharge date for patients within 24 hours of admission, Malec says. “However, after receiving additional feedback from physicians who were concerned about the ability to accurately project the anticipated date for patients with complex medical issues, the goal was updated to assign an anticipated date within 48 hours. Even with the updated goal, clinical judgment remains the priority over an arbitrary date that has no clinical relevance,” she adds.

The discharge collaborative team remains committed to assigning an anticipated discharge date as soon as possible and on keeping the patient and family informed of any updates, she says.

The anticipated date is documented in the medical record and on the communication board in the patient’s room. As soon as the staff can confirm a firm discharge date, they add it to the communication board and the medical record. Then, ideally the day before discharge, the staff adds a specific time for the discharge, Malec says.

“We are able to meet our goal of documenting a confirmed discharge date and time more than 76% of the time. On average, patients leave within 28 minutes of the set time. Our next challenge is to move the discharge time from late afternoon to earlier in the day, ideally before noon,” Malec says.

The discharge collaborative initiative has helped with coordination of care for patients transferring to nursing homes by identifying a set time for discharge, Malec says. “With a set date and time identified, the case managers and nursing staff are able to coordinate the transfer in a more streamlined fashion,” she says. The staff is able to transfer patients during the day when more resources are available at the accepting facility. Knowing the anticipated time for the discharge also helps the family plan, Malec says.

Having a discharge date and time helps the staff to plan and to get their part of the discharge process completed in a timely manner, but things don’t necessarily go smoothly all the time, Malec says. For instance, if a patient is scheduled for discharge the next day at 10:30 but the lab results indicate a problem, the discharge will be delayed until the patient’s condition gets better. “Patient safety is always a priority,” Malec says.

“It’s tricky. We can’t completely firm up the time until the lab tests come back. The pharmacy can’t do medication reconciliation until the discharge orders are signed and the nurse can’t do the final teaching until the medication reconciliation is complete. It’s a work in progress but as it evolves we hope to see improvement,” she says.

Satisfaction scores rose slightly after the initiative was implemented, Malec says.

“While promising, this peak was not statistically significant. Hopefully, with time, we will continue to see sustained improvement in patient satisfaction scores. Anecdotal comments from patients and families have been positive and provide reinforcement that we are moving in the right direction,” she says.