By Eric Wicklund
Patient discharge can be a particularly nasty pain point for hospitals, involving several people from several departments and data from a variety of sources. That, in turn, might make it less than appealing for patients, thus affecting both satisfaction and engagement metrics.
Recognizing the logjams that can occur when leaving the hospital, UPMC has launched a new patient discharge process that consolidates decision-making under one clinical care coordinator and creates a platform for data gathering. The process has shaved 3–4 hours off patient discharge times, improved consult and referral protocols, and boosted HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores by almost 10%.
“Our people have become a blended team … with a new boss,” says Tami Minnier, MSN, RN, FACHE, FAAN, the Pennsylvania health system’s senior vice president of health services and chief quality & operational excellence officer, and the driving force behind the new strategy. “There’s a lot that we’ve been able to improve, and I really think we’re only scratching the surface of what we can gain.”
Minnier says the patient discharge process had grown cumbersome over time, adding in a variety of check-offs and approvals that built up like gravel gathering along the edges of a streambed. Add in the necessary steps to transfer a patient to a rehab or skilled nursing facility or send a patient home, perhaps with remote patient monitoring services or scheduled follow-up appointments, and patients weren’t seeing daylight until late afternoon.
“We had created many, many, many different siloed roles around discharging patients from the hospital,” she says. “It could take six, seven, eight, nine, 10 people to get just one patient out the door.”
Aside from the excessive use of staff and resources, the process also leaves patients and their families waiting to leave the hospital, reducing their satisfaction and, perhaps, causing them to question or avoid post-discharge instructions and follow-up care. Those delays also keep cleaning staff on hold and leave hospital rooms out of commission for longer periods of time.
Minnier’s solution was to create one single, accountable, patient discharge manager who oversees a discharge process that involves fewer people. While that might sound easy, it affected more than 700 people within the health system and involved a good deal of change management.
“Change management and culture were the biggest challenges,” she says, describing a system that included some “embedded and entrenched” habits and attitudes that needed to be changed. “Getting people to think differently about what they do isn’t easy.”
“First of all, we had to recognize that anyone can be a good manager,” she adds. “The first thing was to say, ‘We are all equal,’ and then create an integrated care team that understands situational leadership and how to be accountable. Not everything can or has to be delegated.”
As part of the process, UPMC developed a new clinical leadership ladder and standardized nursing roles, giving everyone a more streamlined approach to the patient discharge process. The health system also redesigned its weekend compensation program, which reduced on-call costs by more than 50%. Again, the idea was to reduce the number of steps and people involved in getting a patient out the door and back home or wherever they were going next.
“We found a lot of redundant work, [such as] unnecessary consults,” Minnier says, estimating the new process cleaned up roughly 157 hours a month of extraneous consults. “We also added cellphones to improve communications, and embedded referrals. We saved hundreds of hours a month there.”
They also took a closer look at pending order sets, and reduced labs and other tests (which reduced needle sticks for the patients). They also fine-tuned the protocols for placing patients in rehab and SNFs, with an eye toward reducing the number of times that a patient has been ready for discharge but isn’t ready to be received at the next care site.
Minnier says the new process is working well, and the health system is getting ready to publish a study and will present it at major healthcare conferences.
But there’s also more to be done. She looks at the network of SNFs, rehab facilities, and other sites that are included in the patient’s journey and wants to “build better bridges” with them, so that the transition is smooth and data is shared quickly and efficiently. This would include strengthening communications with health plans, outpatient clinics, and other resources, such as transportation services, behavioral health providers, and social services.
And with the trend of moving more hospital services into the home, Minnier would also like to strengthen the transition for patients to remote patient monitoring and acute care at home programs.
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.