Case Management Department, Al Hada Armed Forces Hospital, Taif, Saudi Arabia
Medical Administration, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.
BMJ Open Qual. 2023 Jun;12(2). doi: 10.1136/bmjoq-2022-002142.
Overstay of inpatients is a big challenge to healthcare systems which interferes with the proper utilisation of the available resources and efficient delivery of care. Unnecessary days in the hospital may lead to patient complications including healthcare-associated infections, falls and delirium, which can negatively impact both patient and staff experience. This project aimed to reduce the cost of bed days of inpatient overstay through facilitating the discharge process using a multidisciplinary intervention approach.
The root causes of inpatient overstay were defined via a multidisciplinary approach. This project applied the extension Deming Cycle method: Find-Organise-Clarify-Understand-Study-Plan-Do-Check-Act (PDCA). Solutions to the root causes which led to process variation were implemented through three PDCA cycles conducted between January 2019 and July 2020.
There was a significant reduction in the total number of overstay inpatients, the total number of overstay days, and the related bed costs in the first 3 quarters of 2019. A significant and sustained improvement in the emergency department average boarding time was attained in the first half of 2019 (reduced from 11.9 hours to 1.7 hours). A total estimated cost saving of SR30 000 000 (US$8 000 000) in terms of operational efficiency was achieved.
Early discharge planning and facilitating the patient discharge process significantly improves the average length of inpatient stay and patient outcomes and decreases hospital costs.
住院患者的滞留是医疗系统面临的一大挑战，它会干扰资源的合理利用和医疗服务的有效提供。患者在医院的滞留时间过长可能会导致并发症，包括与医疗相关的感染、跌倒和谵妄，这会对患者和医护人员的体验产生负面影响。本项目旨在通过多学科干预方法促进患者出院，从而降低住院患者滞留的床位成本。
通过多学科方法确定住院患者滞留的根本原因。本项目应用扩展的戴明循环法：发现-组织-澄清-理解-研究-计划-执行-检查-行动（PDCA）。针对导致流程变化的根本原因，通过 2019 年 1 月至 2020 年 7 月进行的三个 PDCA 循环实施了解决方案。
2019 年前三个季度，住院患者总滞留人数、总滞留天数和相关床位成本显著减少。2019 年上半年，急诊平均候床时间显著且持续改善（从 11.9 小时减少到 1.7 小时）。在运营效率方面，共实现了约 3000 万里亚尔（800 万美元）的成本节约。
早期出院计划和促进患者出院流程显著改善了住院患者的平均住院时间和患者结局，并降低了医院成本。
