investigating the usage of an estimated date of discharge for occupancy workflow improvement

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Inves&ga&ng the Usage of an Es&mated Date of Discharge for Occupancy Workflow Improvement Flores, K 1 ., Lo, A 1 ., Sla0ery, D 1 ., DasGupta, T. 2 , Gagliardi, L. 2 1. University of Toronto IHI, 2. Sunnybrook Health Sciences Centre Sunnybrook’s overarching goal is to reduce occupancy of acute care beds, however the discharge strategy focuses on: Early communicaMon (from admission) of the discharge plan to paMent and family IdenMfying potenMal factors that can lead to a problemaMc discharge as early as possible, throughout the paMent care period Introduction Objectives Methods Results Results Conclusion Acknowledgements Sunnybrook Health Sciences Centre is frequently experiencing occupancy rates that exceed 100%. A focus area leading to high occupancy rates is the discharge process which, upon admission, handles how and when paMents leave the hospital. There exists a need to ensure that all paMent and family concerns are met up unMl discharge, while at the same Mme ensuring that a Mmely paMent flow and high quality, personcentered experience is maintained. It was determined that communicaMon of an EsMmated Date of Discharge (EDD) would be beneficial to both the paMent family and healthcare staff to improve discharge workflow. The following intervenMons were measured to determine EDD effecMveness: 1. UpdaMng paMent bedside whiteboards with the EDD to encourage proacMve idenMficaMon of concern 2. Care round script (a 4 quesMon tool to help support discharge and person centered care discussions) 3. Feedback from paMents via inpaMent interviews and postdischarge phone call surveys 10 20 286 1 18 EDD Barriers within Sunnybrook control Between Jan 12th & Mar 31st Total 337 whiteboards OR Receiving Treatment Care Decision Pending WaiMng for Consult Insufficient Materials Figure 1: Barriers to why EDD could not be discussed to paMents via whiteboard Figure 2: Results of the care round script to foster discussion of paMent discharge Early feedback from discharged paMents show that only 25% reached the DB11 goal (Fig. 3), however more data is required to determine if improvement is being made. Major barriers to discussing EDD’s were discovered (Fig. 1) and should further undergo deep dive analysis. One notable menMon is that paMents oben disliked the idea of discussing an EDD during admission or the early stages of care. Most paMent comments pertained to their own well being, such as what they need to do in order to stay healthy outside of hospital and only 20% valued being told an EDD (Fig. 3) within the first day of their admission. Next steps could include the creaMon of a process map that captures all current discharge processes. This type of analysis would facilitate accurate idenMficaMon the processes in greatest need of improvement, and would help demonstrate how the those processes affect the others. We would like to thank Tracey Das Gupta, Lina Gagliardi, Florina Weisenberg, and Therese Loo for the opportunity to parMcipate on the Discharge Working Group, and for their conMnuous effort in helping us along the way. 63% 81% 79% 72% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Script Followed Person’s goals/concerns discussed EDD Discussed Team Member iden&fied for follow up % From Total Ques&ons Care Round Compliance 5 Weeks (Between Jan 20th and Mar 27th) Total of 1,031 pa&ents Units: B4, C2, C4, C5, C6, D2, D3, D4, D5, D6ENT and D6URO Figure 3: Feedback from paMents, postdischarge Table 1: Most common comments/concerns from inpa&ent experience surveys Home care (ex. How do I cope living at home?) Family GP Involvement TransportaMon (ex. who will pick me up to return home or move to LTC?) Equipment (ex. How do I obtain a walker?) CCAC CoordinaMon – start the process when paMent is admi0ed 24% 20% 45% 25% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Told EDD during admission EDD within 24 hours valuable? Delays during discharge? Discharged before 11? % From Total Ques&ons Post discharge pa&ent surveys Total of 21 pa&ents May 2, 2015

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Inves&ga&ng  the  Usage  of  an  Es&mated  Date  of  Discharge  for  Occupancy  Workflow  

Improvement   Flores,  K1.,  Lo,  A1.,  Sla0ery,  D1.,  DasGupta,  T.2,  Gagliardi,  L.2  

1.  University  of  Toronto  IHI,  2.  Sunnybrook  Health  Sciences  Centre    

Sunnybrook’s  overarching  goal  is  to  reduce  occupancy  of  acute  care  beds,  however  the  discharge  strategy  focuses  on:      -­‐  Early  communicaMon  (from  admission)  of  the  

discharge  plan  to  paMent  and  family  -­‐  IdenMfying  potenMal  factors  that  can  lead  to  a  

problemaMc  discharge  as  early  as  possible,  throughout  the  paMent  care  period  

 

Introduction

Objectives

Methods

Results Results

Conclusion

Acknowledgements

Sunnybrook  Health  Sciences  Centre  is  frequently  experiencing  occupancy  rates  that  exceed  100%.  A  focus  area  leading  to  high  occupancy  rates  is  the  discharge  process  which,  upon  admission,  handles  how  and  when  paMents  leave  the  hospital.  There  exists  a  need  to  ensure  that  all  paMent  and  family  concerns  are  met  up  unMl  discharge,  while  at  the  same  Mme  ensuring  that  a  Mmely  paMent  flow  and  high  quality,  person-­‐centered  experience  is  maintained.    

It  was  determined  that  communicaMon  of  an  EsMmated  Date  of  Discharge  (EDD)  would  be  beneficial  to  both  the  paMent  family  and  healthcare  staff  to  improve  discharge  workflow.  The  following  intervenMons  were  measured  to  determine  EDD  effecMveness:    1.  UpdaMng  paMent  bedside  whiteboards  with  the  EDD  

to  encourage  proacMve  idenMficaMon  of  concern    2.  Care  round  script  (a  4  quesMon  tool  to  help  support  

discharge  and  person  centered  care  discussions)  3.  Feedback  from  paMents  via  inpaMent  interviews  and  

post-­‐discharge  phone  call  surveys  

10   20  

286  

1  18  

EDD  Barriers  within  Sunnybrook  control  -­‐  Between  Jan  12th  &  Mar  31st  

 Total  337  whiteboards  

OR  

Receiving  Treatment  

Care  Decision  Pending  

WaiMng  for  Consult  

Insufficient  Materials  

Figure  1:  Barriers  to  why  EDD  could  not  be  discussed  to  paMents  via  whiteboard  

Figure  2:  Results  of  the  care  round  script  to  foster  discussion  of  paMent  discharge  

Early  feedback  from  discharged  paMents  show  that  only  25%  reached  the  DB11  goal  (Fig.  3),  however  more  data  is  required  to  determine  if  improvement  is  being  made.    Major  barriers  to  discussing  EDD’s  were  discovered  (Fig.  1)  and  should  further  undergo  deep  dive  analysis.  One  notable  menMon  is  that  paMents  oben  disliked  the  idea  of  discussing  an  EDD  during  admission  or  the  early  stages  of  care.      Most  paMent  comments  pertained  to  their  own  well  being,  such  as  what  they  need  to  do  in  order  to  stay  healthy  outside  of  hospital  and  only  20%  valued  being  told  an  EDD  (Fig.  3)  within  the  first  day  of  their  admission.      Next  steps  could  include  the  creaMon  of  a  process  map  that  captures  all  current  discharge  processes.  This  type  of  analysis  would  facilitate  accurate  idenMficaMon  the  processes  in  greatest  need  of  improvement,  and  would  help  demonstrate  how  the  those  processes  affect  the  others.      

We  would  like  to  thank  Tracey  Das  Gupta,  Lina  Gagliardi,  Florina  Weisenberg,  and  Therese  Loo  for  the  opportunity  to  parMcipate  on  the  Discharge  Working  Group,  and  for  their  conMnuous  effort  in  helping  us  along  the  way.    

63%  

81%  

79%  

72%  

0%   10%   20%   30%   40%   50%   60%   70%   80%   90%  

Script  Followed  

Person’s  goals/concerns  discussed    

EDD  Discussed  

Team  Member  iden&fied  for  follow-­‐up  

%  From  Total  

Que

s&on

s    

Care  Round  Compliance  5  Weeks  (Between  Jan  20th  and  Mar  27th)  

Total  of  1,031  pa&ents  

Units:  B4,  C2,  C4,  C5,  C6,  D2,  D3,  D4,  D5,  D6ENT  and  D6URO  

Figure  3:  Feedback  from  paMents,  post-­‐discharge    

Table  1:  Most  common  comments/concerns  from  inpa&ent  experience  surveys  Home  care  (ex.  How  do  I  cope  living  at  home?)  

Family  GP  Involvement  

TransportaMon  (ex.  who  will  pick  me  up  to  return  home  or  move  to  LTC?)    

Equipment  (ex.  How  do  I  obtain  a  walker?)  

CCAC  CoordinaMon  –  start  the  process  when  paMent  is  admi0ed  

24%  

20%  

45%  

25%  

0%   5%   10%   15%   20%   25%   30%   35%   40%   45%   50%  

Told  EDD  during  admission  

EDD  within  24  hours  valuable?  

Delays  during  discharge?  

Discharged  before  11?  

%  From  Total  

Que

s&on

s  

Post  discharge  pa&ent  surveys  Total  of  21  pa&ents  

May  2,  2015