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Reengineering Patient Discharge with Lean Methodology and RED Framework: A Model for Safer, Faster, Patient-Centered
Sultanah Alharbi1, Lamia Elmassry2, Eidah Aljuaid3
1Department of Case Management, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.
Introduction:
Reorganizing the hospital discharge process to enhance patient experience and reduce avoidable readmissions and costs is an ongoing challenge. At Al Hada Armed Forces Hospital (Taif, Saudi Arabia), we identified a significant issue with the effectiveness and efficiency of our discharge process, with a noticeable effect on patient experience on the basis of Press Ganey surveys (discharge domain). The aim of this project was to improve the efficiency and effectiveness of the discharge process and to enhance patient health outcomes and experience.
Methods:
In this quality improvement initiative, we used Lean methodology and the Re-Engineered Discharge (RED) toolkit to improve the effectiveness of patient discharge processes and the quality of after-hospital care plans. We implemented a multicomponent, evidence-based intervention via three plan-do-check-act cycles, and pre-implementation and postimplementation findings were compared.
Results:
Along the duration of this project (Feb 2022 - Oct 2023), the median discharge cycle time was reduced from 235.5 to 82.5 minutes, and the discharge process cycle efficiency improved from 36% to 60%. The average patient discharge experience satisfaction score increased from 84.16% to 88.25% (p < 0.001), with improvements in noted for "speed of discharge process" and "instructions for care at home" (p = 0.001 and p < 0.001, respectively); in addition, patient experience for the "extent felt ready discharge" rose from the 76th to the 95th percentile. There was a decrease in the average hospital readmission rate for targeted patients within 30 days (from 3.9% to 2.0%) as well as the median percentage of patients visiting the emergency department within 7 days of discharge (from 9.6% to 6.1%). Decreased hospital readmissions were associated with improved operational efficiency in terms of reduced direct bed costs.
Conclusion:
Implementing Lean methodology and the RED toolkit enhanced the effectiveness and efficiency of the discharge process, with a substantial positive effect on the overall patient discharge experience, while reducing hospital readmission rates within 30 days and ED visits within 7 days after discharge.
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