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Communication key to improving throughput
Keep patients, family members in the loop
Improved communication, coordination, and collaboration among all members of the treatment team is the key to improving patient throughput, says Roxanne Tackett, RN, MBA, vice president of clinical services for Compirion Healthcare Solutions, a health care consulting firm with headquarters in Elk Grove, WI.
Case managers tend to be the owners of the throughput process, but all members of the unit have to take ownership to ensure that their patients get the care they need and are discharged in a timely manner, she says.
Everybody on the interdisciplinary treatment team needs to get together and talk about every patient every day, adds Ann Kirby, BA, BSN, MSN, MPA, managing director at Wellspring + Stockamp HuronHealthcare, a Chicago-based consulting firm.
"It is quite a challenge to get everybody together, but the payoff is huge," she adds.
Often, one team member thinks he or she is too busy, but once they start meeting, they realize how a short meeting can increase their efficiency, she says.
"The team can look at the plan of care for today, goals for the patient, barriers for discharge, and ways to resolve them. They don't spend time later trying to track each other down. Having everybody together can make the discharge process much smoother," she says.
The meetings should include a core group of people, including a physician or a physician representative, case managers, social workers, the bedside nurse, and other disciplines as needed. The charge nurse or unit leader should be the facilitator, she suggests.
The meetings should be short and focused on patients being discharged that day, as well as looking at patients who may be discharged in two or three days, and should address any barriers to discharge, Tackett says.
During the meeting, the staff should go over every patient on the unit, the anticipated discharge dates, potential barriers for discharge, current length of stay, and expected length of stay for that DRG, Tackett.
Having regular meetings alerts staff members to what they need to do before discharge. For instance, if a patient will be ready to go home the next day if he voids after his catheter is removed, the case manager knows to get his durable medical equipment or home health services lined up, Kirby adds.
"Patients should leave when they are medically ready and not have their stays extended because tests haven't been done or arrangements for post-discharge care or transportation haven't been made," she says.
If an anticipated discharge doesn't happen, the case manager should initiate an avoidable-day form to have a paper trail of the reasons for the delays, Tackett says.
Track avoidable days on a daily basis to determine if any trends are occurring, and take steps to improve the process, Tackett suggests.
Analyze each avoidable day to determine the cause and whether it's hospital-related or community-related, she suggests.
For instance, the patient may have stayed an extra day because a skilled bed wasn't available, or the family couldn't pick him or her up.
Hospital-related causes may be that there was a delay in orders, the patient didn't get an antibiotic in a timely fashion, or the physical therapy assessment wasn't completed. Nursing needs to be aware of these causes and develop solutions to prevent them from recurring, Tackett says.
The avoidable-day form should be copied and given to the supervisor of the person or department responsible, she says.
When Tackett works with a hospital on patient flow initiatives, she suggests that the staff focus first on the noncomplicated discharges.
"I suggest that each floor try to get two of those easier patients discharged by 11 a.m., two out by noon, and two by 1 p.m. on a daily basis. This assists in reducing bottlenecks," she says.
The average discharge time in most hospitals is after 3 p.m., Tackett says. This is when the hospital typically has fewer resources, such as housekeeping and transportation ,and when the emergency department is beginning to experience peak volumes of patients who need to be admitted.
Lack of communication and coordination between members of the care team and between the care team and the family are the major reasons for delays in discharge, Kirby says.
In addition to verbally notifying the patient and family of when to expect discharge, Tackett suggests putting dry-erase boards in patient rooms and writing the anticipated discharge date along with treatment goals so the staff, the patient, and the family members are aware of when the discharge is likely to occur.