Discharge Timeliness for Mother Baby Couplets: A Six Sigma Project to Improve Throughput
Title: Discharge Timeliness for Mother Baby Couplets: A Six Sigma Project to Improve Throughput
- Review the outcomes of the application of the six sigma methodology to expedite discharges of mother/baby couplets
- Analyze the processes that were engaged in the project to improve discharge timeliness
- Correlate process changes to improved patient satisfaction, improved quality of care, reduction of newborn re-admissions, and improved nurse/patient ratios
Purpose for the program :
The purpose of the project was to improve the throughput and discharge timeliness of Mother/Baby couplets. The capacity on the Mother/Baby Unit delayed care of the patients admitted to the Labor and Delivery Unit for treatment and delivery. Six Sigma methodology application was enlisted to improve the care at discharge and provide a seamless dischare transition. Baseline measurements revealed that only 30% of mother/baby couplets were discharged by noon.
Proposed change:
The maternity throughput goals were:To improve the time the patient left the hospital by 1200 from 31.5% to 50%, 75% of Mother/Baby couplets will departing within 90 minutes of the last discharge,and to improve the skill level of the charge nurse to manage throughput.
Implementation, outcomes and evaluation :
An interdisciplinary team addressed processes. Methodology of Lean Six Sigma was applied. An improvement of 1.5% (30.5%) was realized. Areas that were stabilized through collaboration of the team were the services provided the day before discharge. Baseline data concluded that 69.1% of discharged patients left after 1200,55% of the deliveries occurred during the time frame,andlow throughput was identified. Lack of capacity to accomodate delivered patients during periods of the day was identified. Stabilization of services before the day of discharge did not significantly improve throughput. Processes on day of discharge were not addressed: Charge Nurse ability, Staff nurse ability, Patient readiness for discharge, infant care, and physician discharge timeliness. Implementation Strategy included "Designated Charge Nurses" were prepared,Maternity Discharge Work Flow indicator developed and rapid Cycle testing done X3. Charge nurse ability was improved. Eectronic discharge alert for mother and for baby was created. Maternity Expected Discharge List was completed each evening. Lactation Consultation and documentation was developed within EMR. Photo Therapy Equipment Consignment eliminated wait for delivery and decreased readmissions for hyperbilirubinemia. The use of Teletracking and Transport aide expedited patient leaving the floor. Maternity staff remained to care for other patients. Rapid cycle outcomes were: 47% of mother/baby couplets leaving the unit within rapid cycle three. Discharge departures within 90 minutes of the last discharge declined. Individual services and personal choice impacted the data for couplet discharges. Average discharge time by 1200 improved to 83%. Discharge time by 1200 has been normalized with correlation of consistency of application of processes.
Implications for Nursing Practice:
Improved Staffing ratios enhanced ability to promote discharge timeliness. Patient perception improved. Documentation for lactation services improved quality of care. Newborn readmissions declined by 75%.
Keywords: Throughput, discharge timeliness, patient satisfaction.