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Discharge planning: Having patients out by noon

Patient Access Weekly Advisor, November 7, 2007

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In most inpatient settings, the same scenario plays out every morning. It's 11 a.m., and patients from the ED and operating room (OR) are in need of a bed. However, there is none available because the hospital staff has not prepared the current inpatient for discharge.

Despite the link between delayed discharges and afternoon bottlenecks, more than 50% of hospitals across the country are still averaging a discharge time of 3 p.m. or later.

"The problem is old, and the numbers are consistent nationally," said Bud Pate, REHS, practice director for The Greeley Company, a division of HCPro, Inc., in Marblehead, MA, during the HCPro audioconference "Patient Flow Solution Series: Discharge patients by noon."

According to Pate, everyone from the executive suite to housekeeping knows the hospital must discharge patients earlier.

The problem lies in the bureaucracy, which gets in the way and prevents early discharge from happening.

"The bed demand is also obvious, but we're just ignoring it," said Pate. "We know we're going to need beds starting at 10 a.m., 11 a.m., and noon from the ED. We know our OR schedule, so we know when we'll be getting the beds. And yet, we're discharging patients later in the day, so we also know that there will be a disconnect."

Pate said that hospitals track this type of data, but not enough. He recommended that hospital staff members have current discharge, length of stay, and scheduling data in front of them at all times, and that they use this information to organize and prepare.

In particular, Pate said the most crucial element is motivating the frontline staff.

"You have to put the pain where the solution lies," said Pate. "If you don't make the frontline caregivers directly responsible-if you shield them from this pain-there's a thousand ways that they can get around the issue."

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