additional assessment or orders prior to discharge, the team continues to process most of the patients out early in the day. The change agent’s role must be to encourage the physicians, at first the surgeons, to make this change in practice. By providing logistical and scheduling support, they can make the transition easier. With the resulting decline in waiting hours, the increased movement of patients through PACU and therefore the OR will help with scheduling surgeries and directly benefit the
LEADERSHIP C158 10 surgeons. Their patients will be happier to leave the hospital at a reasonable hour and therefore happier with the experience as a whole. There will be difficulties in maintaining this practice. Many of the facilities that have instituted a scheduled discharge time do so with a hospital wide roll out of placards for each room, announcements made at staff meetings and increased scheduling of discharge planners and care coordinators to help with the transition. Notes given to each newly admitted patient inform them of the discharge time and make them aware of the expectation to be ready to leave at that time. It also drives them to push staff to have their discharge packet ready on time as the patient has done their part and is ready to leave. Exceptions will be made for special circumstances, but the majority of patients will be discharged in the am and the rooms ready for new patients by early afternoon. Over time, the new discharge time will become the norm. The change agent can move on to the next challenge. The extra shifts worked by the discharge planners and care coordinators will no longer be necessary. The expectation on the staff and new patients will be a morning discharge and the resulting decrease in waiting times and staff expense, and increase in patient satisfaction, can be measured to demonstrate the positive results to the staff. C. 2. The system, or lack thereof, in place today shows a small group of patients leaving in the morning, other groups spread out across the day and a large number discharged after 1700. The delay in making these beds available earlier is felt throughout the hospital. Patients are being held in the emergency department, creating a wait and leading to an increased number of patient leaving without being seen. This is lost business for the hospital. The PACU is holding patients
LEADERSHIP C158 11 which slows down the OR, another loss of revenue. The increased staffing in the evening hours necessary to discharge patients, clean beds and admit patients is more expensive due to evening differentials in staff pay. In the short term, the change agent, extra discharge planners and care coordinators and other staff can mean an increased expense. There will be an expense in printing out and posting notices in each room of the scheduled discharge time and contact info for discharge support. The staff education can be rolled into regular meetings and should not amount to much.
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- Winter '20
- Health care provider, Discharge Planners, LEADERSHIP C158