Improving Early Discharge Using a Team-Based Structure for Discharge Multidisciplinary Rounds.

Area of Science:

• Healthcare Management
• Patient Discharge Process
• Quality Improvement in Medicine

Background:

• Patient discharge involves complex communication, often leading to adverse events and dissatisfaction.
• Current case manager (CM) assignments by unit location fragment communication for medicine teams.
• Inefficient communication in discharge planning can increase patient length of stay (LOS).

Purpose of the Study:

• To implement and evaluate team-based multidisciplinary discharge rounds (MDR) for general internal medicine patients.
• To improve communication and efficiency in the discharge planning process.
• To assess the impact of MDR on patient LOS and readmission rates.

Main Methods:

• A pilot study using a continuous improvement model was conducted at a tertiary academic medical center.
• Multidisciplinary discharge rounds (MDR) were implemented and optimized on 2 of 4 internal medicine resident ward teams.
• Patient data, including discharge times, LOS, and 30-day readmissions, were compared between pilot and control teams.

Main Results:

• The pilot MDR teams showed a higher proportion of patients discharged before noon (41.2% vs. 29.6%).
• Pilot teams experienced a shorter average LOS (92.2 hr vs. 97.2 hr) and lower 30-day readmission rates (16.0% vs. 18.3%).
• After the pilot, a return to the unit-based CM model negated these improvements, indicating the effectiveness of the team-based MDR approach.

Conclusions:

• Team-based MDR significantly improved interdisciplinary relationships and communication.
• The MDR pilot resulted in shorter LOS, earlier discharge times, and reduced 30-day readmissions.
• This model highlights the benefits of integrated, team-based discharge planning for optimizing patient care.