Discharge When Medically Ready.

QUALITY PROBLEM

The timing and pace of patient discharges are not level-loaded throughout the day at many institutions including ours, an academic medical center and adult Level I trauma center located in Milwaukee, Wisconsin.

INITIAL ASSESSMENT

Only 4% of patients were being discharged with rooms marked dirty by 11 AM at our institution.

CHOISE OF SOLUTION

We put together a multidisciplinary team of approximately 30 stakeholders to develop a revised process that focused on coordination of discharge activities, plan of care awareness among team members, and communication with patients and families.

IMPLEMENTATION

The discharge process was piloted and iteratively adjusted on a single medicine floor.

EVALUATION

Our interventions made a noticeable impact on median room "ready to be cleaned" (RTBC) time without having an adverse impact on length of stay. RTBC improved by a median of 39 minutes ( = 0.019), and the proportion of rooms ready to be cleaned by 11 AM increased from 4.19% to 8.13%.

LESSONS LEARNED

Having a multidisciplinary team participate in the evaluation and development of a new process was critical. Additionally, implementing solutions on a single unit allowed for rapid iteration of changes.