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Improve patient flow

Patient Access Weekly Advisor, October 31, 2007

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Like many hospitals, St. Joseph's Medical Center (SJMC) in Townsend, MD, had a universal discharge time system in place with a goal of getting all patients discharged by 11 a.m.

In an effort to even patient flow and create balanced scheduling throughout the day, Jackie Connor, RN, MS, CCS, director of case management at SJMC, along with her task force of nurses, physicians, social workers, and ancillary staff members, abolished universal discharge times and switched to a discharge-by-appointment system.

SJMC case managers and members of the task force now make daily rounds to identify patients who are almost ready to be discharged. Once a patient has been identified, a case manager or nurse contacts the physician to get his or her approval, and a scheduled discharge is made 24-48 hours in advance.

Discharge appointments are made throughout the day-mornings, afternoons, and early evenings-based on patient, family, and physician needs.

"After an appointment has been made, it goes into the computer system, and the physician is reminded, and the ancillary departments are notified so they can prepare necessary labs and tests ahead of time instead of having to scramble at the end," says Connor. "This structure allows doctors and ancillary staff time to prepare and eliminates some of the surprise factors that come along with patient discharges."

Under a scheduled system, if a physician wants to see a final chest x-ray or a blood test, the ancillary staff is alerted ahead of time and can prepare to have these exams ready, adds Connor. The ancillary department's goal is to have all requested tests three hours before a patient's scheduled discharge time. This way, says Connor, if anything unexpected arises, the department has time to review and preplan.

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