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Bottleneck breakdown: Resolve your discharge process first

Patient Access Weekly Advisor, August 29, 2007

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People often point to long wait times in the ED as the source of bottlenecks in the patient access process. However, the problems do not always originate at the beginning of a hospital visit; instead, the end of the process-the discharge-is often to blame.

Lehigh Valley Hospital in Allentown, PA, learned this lesson during a three-year period.

In 2001, the hospital administration made it a priority to solve this growing problem. The hospital held a retreat with leadership from every department in the hospital.

Modeled after similar programs at Southwest Airlines, the group identified where it thought the problems began. Terry Capuano, RN, MSN, MBA, senior vice president of clinical services, formed teams to look at each problem. Between 2003 and 2005, the hospital took on 17 projects aimed at reducing bottlenecks.

As a result of these early projects, Lehigh adopted the following changes to improve the discharge process and reduce bottlenecks:

Patient logistic system. Before Lehigh Valley examined and revised its discharge process, volunteers or staff members from the unit were transporting patients, but patients were often ready to go for a long time before someone came for them, Capuano says. As a result of Lehigh's initial projects, the organization created a patient logistics system. A transporter is now called, so no one from the unit has to leave the floor to escort a patient. The time to prepare a bed for a new patient has been reduced from 210 to 60 minutes, and that figure has held steady for two years.

Improved ancillary services. The hospital sought to improve the availability of ancillary services so that physicians could get an early look at test results. The organization also identified and prioritized tests that are needed for discharge.

Modified rounds. When identifying obstacles to early discharge, the group noted that teaching rounds delayed the discharge process. Although physicians had traditionally made their rounds in the morning, the physicians were willing to try a different way.

Physician extenders. Other physician groups were likewise willing to consider changes. The cardiothoracic surgery group hired a nurse practitioner to be on the units while they were in surgery. That extender helps get patients ready for discharge and handles tasks such as patient education. The group was able to shave 1.4 days off the length of stay in the past year and still maintains the best cardiac surgery outcomes in the state.

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