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Discharge delays can lead to patient dissatisfaction

Patient Access Weekly Advisor, August 8, 2007

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Pricing and quality transparency are now buzzwords with long-reaching financial implications for both providers and patients. Now, more than ever, hospital administrators believe strong customer service may be the "X" factor that will retain customers and their business.

Providers must examine every process to ensure that it's not only efficient for the hospital, but also appealing for the patient.

However, one particular process-discharge planning-can be a headache in any setting. Leaving the hospital ranks among the most anticipated and stressful moments of a hospital experience for patients and their families. Yet, all too often, patients get delayed in the discharge stage of their hospital visit, just when they're ready to go home.

Delays in discharge have long affected length of stay (LOS) and patient flow, but numerous studies now show a direct link between a hospital's discharge planning process and overall patient satisfaction. A patient's perception of the discharge process has become a crucial component to overall satisfaction and hospital loyalty.

"A good discharge experience leaves the patient with positive emotions and a strong affinity for returning to the facility," said Paul Clark, MPA, MA, CHE, senior knowledge manager for Press Ganey Associates in South Bend, IN, during the HCPro audioconference "Optimizing the Discharge Process: Improve Patient Flow, Reduce Length of Stay, and Increase Patient Satisfaction."

"A negative experience can override the good impressions and positive considerations that were formed throughout the patient's stay in the hospital," said Clark. Since 2002, Clark and other researchers at Press Ganey have studied ways of optimizing the discharge planning process using evidence-based best practice methodologies.

They performed a data analysis of more than 1,600 of their top-scoring and top-performing facilities and conducted interviews with officials at each hospital to generate in-depth feedback.

Change begins in the mirror

The first step to optimize your discharge planning process is understanding what it looks like from the patient's perspective, said Clark. "Then you can start to envision your own ideal process. You can start to identify the gaps between reality and your envisioned ideal."

Next, to help understand and create an ideal discharge planning process, Clark recommended using the Joint Commission and American Medical Association (AMA) standards for discharge planning as a framework.

Both The Joint Commission and the AMA require hospitals to provide an assessment of a patient's learning needs, abilities, preferences, and readiness that considers culture, religion, emotional barriers, physical and cognitive limitations, language barriers, and financial implications.

"The standards are very comprehensive and challenging, but they're good," said Clark. "You should ask yourself, 'How often are we hitting these standards'? How do we do this? Do we do it each and every time or only when we have complex cases?"

After framing your discharge process around the Joint Commission and AMA standards, the Press Ganey researchers recommend you structure your process based on your patients' needs. "Patients need to know many things," said Clark."They want to know when they will be going home and what they will have to go through on the day of discharge. They want to feel safe and prepared for a transfer, if needed. They want all of their questions answered, their feelings considered, their families involved, and a continuous healing relationship with their care providers."

To measure and quantify these goals, Press Ganey divided the discharge process into four distinct areas of evaluation on their surveys. Press Ganey judges a hospital's discharge process largely by how patients respond to these crucial factors:

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