Hospital slashes discharge wait time

Redesigns patient transportation, charting

St. Francis Hospital & Health Center in Blue Island, IL, slashed in half the time patients wait to be discharged by decentralizing patient transportation and redesigning charting procedures.

A year ago and prior to the changes, patients waited to be discharged an average 2.8 hours after physicians wrote the discharge orders. That time lag has been cut to 1.5 hours, says Pat Sutton, LCSW, manager of support services, which includes social services and registration.

The changes were part of an overall patient-focused care restructuring initiative. The excessive wait for discharge was one of the areas targeted by a continuous quality improvement team which found several factors contributing to the wait. One was an inefficient patient transportation system in which patients would have to wait for someone to arrive with a wheel chair and escort them to their car. To streamline the process, the hospital decentralized the patient transportation department and added the duty to a new multiskilled position on the nursing floor called a unit support partner. Now, nurses notify the unit support partners, who are already on the floor and can report to the patient immediately with a wheelchair.

A second factor contributing to the delay was a chaotic system for storing charts. Physicians did not know what to do with a chart after they wrote an order on it, Sutton explains. Charts were handled in a variety of ways: Some nursing units were using door-side charting, a system in which charts are left on the door of the patient’s room; some kept the chart at the nurses’ station; and some moved the nursing component of the chart to the door-side and left the rest at the nurses’ station.

For a few thousand dollars, the hospital installed racks at all nursing stations for charts with written orders. Charts are kept door side until they contain written orders, at which time they are put in the rack. Any caregiver seeing a chart in this rack now knows it contains orders that need to be attended to, Sutton says.

The process was further streamlined with a new discharge form in which all patient discharge instructions are documented on a single discharge sheet at the time of the intervention, rather than waiting until the day of discharge. (See discharge form, inserted in this issue.)

The form debuted successfully, but has recently encountered a problem: some ancillary departments were not entering their information on the discharge sheet, Sutton says. A nurse, faced with an incomplete sheet, has to read through forms in the chart and figure out who has referred the patient to do what.

"We’re working on doing more education with the [ancillary] departments, trying to better identify responsibility — who needs to do it and when," Sutton says.

[Editor’s note: For more information about streamlining discharge procedures, contact Pat Sutton, St. Francis Hospital & Health Center, 12935 S. Gregory St., Blue Island, lL 60406. Telephone: (708) 597-2000, ext 5266.]

Boland, P. Redesigning Healthcare Delivery: A Practical Guide to Reengineering, Restructuring and Renewal. Berkeley, CA: Boland Healthcare; 1996.

More than 70% of re-engineering efforts in the health care setting suffer from poor leadership, short-sighted downsizing, and piecemeal implementation, according to a recently released book.

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More than 60 experts spend 940 pages and 40 chapters sharing advice on restructuring health care to cut costs, improve quality, and satisfy patients.

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Radical, aggressive approaches used

The book promotes radical, aggressive, and comprehensive re-engineering. The book offers examples of organizations which went beyond revamping a particular service or department to redesigning an entire hospital or HMO around the patient’s perspective. It also explains that senior level managers must commit themselves to investing in re-engineering as an ongoing way of doing business.

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[For more information about the book, contact Boland Healthcare. Telephone: (800) 437-7030. Fax: 510-524-4607. E-mail: boland@vdn.com.]