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Identifying Discharge Delays: A Multidisciplinary Quality Improvement Initiative
Kavya Bana1,2, Kristin Myers3, Katherine Woo1
1Department of Medicine, University of Rochester, Rochester, NY.
Summary
A new program successfully increased the documentation of medically ready for discharge dates (MRDD) and discharge delays (DDs) in electronic medical records (EMR). This initiative improved tracking of patient flow and identified social vulnerability as a key factor in delays.
Area of Science:
- Healthcare Management
- Patient Flow Optimization
- Health Informatics
Background:
- Hospitals face challenges in efficiently managing patient discharge.
- Accurate tracking of discharge delays is crucial for resource allocation and patient flow.
- Electronic Medical Records (EMR) offer a platform for improved data collection on discharge barriers.
Purpose of the Study:
- To increase the documentation rate of discharge delays (DDs) from 1.7% to at least 10% for hospitalized patients.
- To identify trends in discharge delays, particularly among vulnerable populations.
- To streamline patient flow by understanding and addressing reasons for extended hospital stays.
Main Methods:
- Implementation of Plan-Do-Study-Act cycles to improve DD documentation.
- Utilized interdisciplinary communication (in-person, email) and EMR modifications.
- Stratified discharge delay types by patient social vulnerability index.
Main Results:
- Sustained documentation of DDs above the 10% target, peaking at 24%.
- Common discharge delay themes identified: Placement, Disposition, Consult, and Home Coordination.
- Patients with higher social vulnerability index experienced disproportionately more delays (Consult, Home Coordination, Transportation).
Conclusions:
- The implemented program effectively increased discharge delay documentation in the EMR.
- Discharge delay data reveals significant impact of social vulnerability on patient flow.
- Understanding these delays is key to targeted interventions for vulnerable patient groups.
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