Problem: Hospitals face capacity challenges caused by the ongoing pandemic with high census compounded by staffing shortages. Expediting patient discharge is crucial to promoting patient access and efficient throughput. Our hospital established an interprofessional discharge SWAT team to develop improvement strategies, overcome daily discharge barriers, and ultimately decrease length of stay.
Measurement: A current state assessment included review of baseline length of stay (LOS) data, discharge times, and delay reasons. Stakeholders identified discharge tasks resulting in creation of a process flow diagram and discharge delay contributing factors were outlined via fishbone diagram. Over time, discharge SWAT team impact was measured more specifically.
Analysis: Information technology created daily lists for observation and 4-7-day LOS patients. An automated spreadsheet is completed during team discharge huddles indicating providers present and patient details. Spreadsheets are analyzed using Microsoft PowerBI as well as LOS dashboard data. Observation to inpatient status changes are also gathered. All results are compared.
Implementation: A discharge SWAT team was formed inviting all department of medicine providers and interprofessional department leaders to join a daily discharge huddle call focused on discharging observations patients and inpatients with a LOS between 4-7-days. Provider participation was an obstacle overcome by the team solving discharge barriers for their patients.
Results/Discussion: Observation average LOS decreased 0.06 days, and inpatient average LOS decreased 0.27 days, reflecting a 2.5% and 4% improvement respectively. There was 0.21 day decrease in observation LOS for providers participating in the huddles versus those who don’t. Keeping huddles brief and solution-driven contributed to increased participation and improved outcomes.