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PROPEL Discharge: An Interdisciplinary Throughput Initiative
Joint Commission Journal on Quality and Patient Safety
|December 5, 2024
Summary
Increasing early morning hospital discharges significantly improved patient flow and reduced length of stay. This quality improvement initiative demonstrated that timely discharges are safe and achievable through collaborative efforts.
Area of Science:
- Healthcare Management
- Quality Improvement Science
- Hospital Operations
Background:
- Healthcare institutions face strained resources due to increased care demands, leading to emergency department (ED) congestion, safety events, and dissatisfaction.
- High volumes of afternoon discharges exacerbate limited early morning bed availability and create admission bottlenecks.
Purpose of the Study:
- To improve discharge timeliness, reduce length of stay (LOS), and enhance ED throughput.
- To increase the rate of discharges completed before 11:00 a.m. through a quality improvement project.
Main Methods:
- A 29-month pre-post design quality improvement project was implemented across 19 acute care, adult medicine units at a large academic medical center.
- Interventions included standardized interdisciplinary discharge processes, performance data transparency, a recognition program, and a barrier tracking and mitigation process, based on Lean Six Sigma methodology.
Main Results:
- Pre-11:00 a.m. discharges increased from 5.1% to 21.8% (p < 0.001), with earlier discharge orders and patient releases.
- Median LOS decreased by 0.46 days (p < 0.001), and ED admissions arrived 44 minutes earlier (p < 0.001).
- Increased bed capacity by 18.84 beds per day was achieved through opportunity day reductions.
Conclusions:
- Early morning discharges are associated with improved patient throughput, demonstrating safety, achievability, and sustainability.
- Key interventions include frontline engagement, interdisciplinary collaboration, standardization, barrier mitigation, data accessibility, and accountability.
