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. 2022 Aug 1;7(4):e587.
doi: 10.1097/pq9.0000000000000587. eCollection 2022 Jul-Aug.

Quality Improvement Initiative Increasing Early Discharges From an Acute Care Cardiology Unit for Cardiac Surgery and Cardiology Patients-Associated With Reduced Hospital Length of Stay

Jessica Colyer  1 , Lisa Ring  2   3 , Sarah Gallagher  2 , Mary Mullenholz  2 , Jan Robison  2 , Kathleen Rigney-Radford  2 , Ashraf S Harahsheh  2   3
Affiliations

Quality Improvement Initiative Increasing Early Discharges From an Acute Care Cardiology Unit for Cardiac Surgery and Cardiology Patients-Associated With Reduced Hospital Length of Stay

Jessica Colyer et al. Pediatr Qual Saf. .

Abstract

Discharging patients from the acute care setting is complex and requires orchestration of many clinical and technical processes. Focusing on timely discharges improves throughput by off-loading ICUs and coordinating safe outpatient transitions. Our data review demonstrated most discharges occurred later in the day. We sought to improve our discharge times for cardiology and cardiovascular surgery (CVS) patients in our 26-bed inpatient acute care cardiology unit (ACCU). We aimed to increase the number of discharges between 6 am and 12 pm for cardiology and CVS patients on ACCU from 5 to 10 patients per month over 6 months and sustain.

Methods: We performed a simplified Failure Mode Effect Analysis on the discharge process and identified improvement opportunities. Our key drivers centered around education, documentation, and planning. Our interventions included: staff education, communication of discharge expectations, daily quality board rounds, hospital-wide collaboration emphasizing conditional discharges, and hospital information technology (IT) improvements. We utilized statistical process control charts to analyze the data.

Results: Discharges between 6 am, and 12 pm increased from a baseline of 5 (8%) to 12 (18%) patients per month with a centerline shift. Our process measures demonstrated appropriate conditional discharge usage linked to earlier discharges. Upgrades to our EMR, documentation further increased our timely discharges. Our efforts resulted in a 22% reduction in hospital length of stay from 11.2 to 8.7 days without increased readmission rates suggesting that improved efficiency did not impact care quality.

Conclusion: We successfully show how multidisciplinary collaboration and systems-based improvement can increase the number of safe, early discharges.

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Figures

Fig. 1.
Fig. 1.
Key driver diagram.
Fig. 2.
Fig. 2.
Graphic illustration of bear steps to home.
Fig. 3.
Fig. 3.
Discharges between 6 am and noon by month (December 15–19)—I Chart.
Fig. 4.
Fig. 4.
Average discharge time by month (December 15–19)—XbarS Chart.
Fig. 5.
Fig. 5.
LOS by month (December 15–19)—XbarS Chart. LOS, length of stay.
Fig. 6.
Fig. 6.
Run chart of percentage of appropriate conditional discharge orders for CVS and cardiology. CVS, cardiovascular surgery.
See this image and copyright information in PMC

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