University of Wisconsin–Madison Medical College of Wisconsin

Discharge When Medically Ready

Yogita Sharma Segon, MD; Christopher Emanuel, BS; John P. Gaspich III, BS; Verna Seitz, MS, RN, NEA-BC; Christine S. Buth, MHA, BSN, RN, NE-BC; Sarvpreet Ahluwalia, MD; Neha Sharma, MD; Ankur Segon, MD, MPH, SFHM

Published online ahead of print June 23, 2022.

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ABSTRACT

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.

Choice 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 (P = 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.


Author Affiliations: Division of General Internal Medicine, Medical College of Wisconsin (MCW), Milwaukee, Wisconsin (Segon YS, Ahluwalia); Department of Quality and Process Improvement, Froedtert Hospital, Milwaukee, Wisconsin (Emanuel); Pennsylvania State University College of Medicine, Pennsylvania (Gaspich); Froedtert Hospital, Milwaukee, Wisconsin (Seitz); Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio (Sharma); University of Texas, San Antonio, Texas (Segon A).
Corresponding Author:  Ankur Segon, MD; email segon@uthscsa.edu; ORCID ID 0000-0002-3320-3141.
Acknowledgement: The authors would like to thank all of the “Discharge When Medically Ready” team members who contributed to development of this process and the 5SE for being the pilot implementation unit.
Funding/Support: None declared.
Financial Disclosures: None declared.
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