Simple changes reduce discharge waiting time

Patient-focused care contributes to solution

Patients who are ready to leave the hospital usually want to do it as quickly as possible. They certainly don’t want to sit around for hours while hospital personnel clear away the final obstacles.

A year ago, patients at St. Francis Hospital & Health Center in Blue Island, IL, could count on spending an average of 2.8 hours waiting to leave. But by changing the way patients are transported and providing a uniform system for storing charts with written orders, the hospital has cut almost in half the time it takes to get patients out the door. Now, patients on average spend 1.5 hours waiting after physicians write their discharge orders, says Pat Sutton, LCSW, manager of support services, which includes social services and registration.

Under a patient-focused care restructuring, the transportation department was eliminated and new "unit support partners" on the nursing floors became responsible for the final discharge step — taking patients from the floor to their car in a wheelchair, Sutton says. Instead of waiting for transportation department personnel, nurses notify the unit support partners, who are already on the floor and can get a wheelchair immediately to transport the patient.

Members of a continuous quality improvement team studying the wait time problem uncovered another cause for delays; there was no standard place to leave charts with written orders.

Physicians never knew what to do with a chart after they wrote an order on it because of the different ways charts were handled, Sutton says. Some nursing units used doorside charting, meaning charts were left on the door of the patient’s room. Others kept the chart at the nurses’ station, and still others moved the nursing component of the chart to the doorside and left the rest at the nurses’ station.

At a cost of a few thousand dollars, racks for charts with written orders were installed at all nursing stations. Any caregiver seeing a chart in this rack now knows that it contains orders that need to be attended to, she says. Things became even simpler when it was decided that all charts will be kept at doorside until they contain written orders, at which time they’ll be put in the rack.

The hospital also began having all patient discharge instructions documented on a single discharge sheet at the time of the intervention, rather than waiting until the day of discharge. (See discharge form, p. 10.)

This worked initially, but lately some ancillary departments have not been adding their elements to the discharge sheet, Sutton says. A nurse faced with a discharge sheet that’s not fully filled out 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 explains.