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. 2023 Aug 3;94(4):e2023196.
doi: 10.23750/abm.v94i4.14469.

Implementation of a centralized discharge planning office during the COVID-19 pandemic: translating the experience from the emergency to routine clinical practice

Fabrizio Pregliasco  1 , Barbara Caimi  2 , Roberto Falco  3 , Giuseppa Valentini  4 , Federico Capello  5 , Matteo Pellegrini  6 , Miranda Valtorta  7 , Elisabetta Curci  8 , Federica Bertozzi  9 , Giuseppe Calicchio  10
Affiliations

Implementation of a centralized discharge planning office during the COVID-19 pandemic: translating the experience from the emergency to routine clinical practice

Fabrizio Pregliasco et al. Acta Biomed. .

Abstract

Background and aim During the COVID-19 emergency, the lombardy region (northern Italy) implemented a regional Centralized Discharge Planning Office (CDPO) to promptly manage the discharge requests, rapidly match the needs of discharge hospitals with the availability of admission facilities and ensure the management of the entire discharge process. To improve the discharge process in routine clinical practice, maintaining the role of the CDPO could be of great interest. This paper describes the experience of the CDPO during the COVID-19 pandemic and discusses the possibility to translate this operational model to routine clinical practice.

Methods: The PRIAMO web portal was developed to manage discharge requests with centralized and standardized procedures. The activity on PRIAMO consisted of three stages: discharge request, sorting process, and discharge follow-up phase. To evaluate the activity of the CDPO, these indicators were considered: average time (hours) between patient discharge and transfer acceptance; average time (hours) between patient discharge and effective admission to the new facility; percentage of transfers whose destination was found directly by the CDPO; percentage of reallocations beyond 24 hours; mean distance between discharge and admission facilities.

Results: Process indicator evaluation showed a great reduction in the time between the discharge and the admission to post-acute care facilities. Transfers whose destination was found directly by the CDPO progressively increased. Reallocations beyond 24 hours by the CDPO decreased, suggesting an improvement in the quality of the operations.

Conclusions: Centralized discharge planning has enabled timely and efficient management of discharge requests even in the moment of a surge, saving time and costs for acute care hospitals.

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Conflict of interest statement

Each author declares that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.

Figures

Figure 1.
Figure 1.
Schematic diagram of the CDPO operation process. 1. Discharge request: the hospital that needs to discharge a patient fills out a form in PRIAMO based on patient category (COVID, COVID-free, negativized patient), which contains clinical information and patient classification. 2. Sorting process (CDPO): the discharge facility is authorized to report in PRIAMO any direct agreement with the admission facility or to request the CDPO intervention to identify an appropriate destination. 3. Discharge follow-up phase (admission facility): Following patient assignment, the admission facility proceeds to admit or reject the patient, then reports the date of admission and final discharge on PRIAMO. The sorting process is repeated in case of refusal by the admission facility.
Figure 2.
Figure 2.
Distribution of transferred COVID-19 (A) and COVID-19-free (B) patients (y-axis) by main disease (x-axis).
Figure 3.
Figure 3.
The number of patients transferred (y-axis) sorted by disease (COVID-19 and COVID-19-free) per day (x-axis).
Figure 4.
Figure 4.
The number of COVID-19 patients transferred by the combination of CIS (x-axis) and CDS (y-axis) scores.
Figure 5.
Figure 5.
(A) Mean time (hours, y-axis) between the discharge and the transfer acceptance per day (x-axis). (B) Mean time (hours, y-axis) between the discharge and the effective admission of the patient per day (x-axis). (C) Percentage of transfers (y-axis) whose destination was directly found by the CDPO per day (x-axis). (D) Percentage of reallocations beyond 24 hours (y-axis) among patients whose beds were found directly by the CDPO per day (x-axis). (E) Mean distance (km, y-axis) between discharge and admission facilities per day (x-axis).
Figure 6.
Figure 6.
Trend of the estimation of setting appropriateness error.
Figure 7.
Figure 7.
Customer satisfaction survey scores were reported by discharge facilities (n=48) (A) and admission facilities (n=58) (B).
See this image and copyright information in PMC

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