Strategies to Facilitate Earlier Discharge Times on Postpartum Service
- Describe the basic elements of an Real Time Demand Capacity bed management system
- Analyze your own patient satisfaction survey to select questions reflective of the discharge process
- Identify bottlenecks in your facility that impede earlier discharge times
August 2009: 21% of mothers and 18% of newborns were discharged by 2pm. With an average occupancy of over 81% during August 2009, it became obvious that a dramatic change in daily operations was necessary to improve patient flow through the Obstetrical Service.
Proposed change:
To double the percentage of mothers and newborns discharged by 2pm by building a framework to support Real Time Demand Capacity (RTDC) management and proactive discharge orchestration.
Implementation, outcomes and evaluation:
In the fall of 2009, we created a Census Alert Scheme, with action items to address surges. In early 2010, we began bed huddles at 8am and 8pm to forecast admission and discharge activity and create plans to match bed demand and capacity. This was followed by the development of a process for discharge prediction. At the unit level, the nursing staff focus is on round-the-clock discharge orchestration.
Some of our key successes are the creation of a partnership with the medical staff, environmental services and escorts, successful behavior changes through one-to-one behavior modeling, the revision of a nursing shift hand-off tool to include key elements of discharge activity, shifting the execution of key discharge tasks from day of, to day prior, to discharge, the initiation of interdisciplinary rounds, with focus on milestones for discharge, the development of a medical care algorithm for routine postpartum and c-section patients, the creation of care maps to manage patient/family expectations, and use of a discharge checklist for mother and newborn.
Over the past twelve months we have seen dramatic improvements in the percent of mothers and newborns discharged by 2 pm. A by-product of our work has been the improvement in scores on four of our patient satisfaction questions.
Mothers: Performance at or above target (42% of patients discharged by 2pm) for 23 of past 25 weeks
Newborns: Sustained performance above target (36% of newborns discharged by 2pm) for 24 of past 25 weeks
Patient Satisfaction questions showed improvement over twelve months:
Help arranging Home Care Services-43% improvement
Instructions given about care at home-8% improvement
Staff worked together to care for you-6% improvement
Speed of the Discharge Process-20% improvement
Implications for nursing practice:
Discharge orchestration requires a reframing of nursing staff focus and priorities. Once a framework has been established to support success, nursing practice can shift to be more of a working partnership with the new family.
Keywords: patient flow, discharge planning
