PV: What was the afternoon like before this process?
Explore This IssueACEP Now: Vol 35 – No 12 – December 2016
KH: Our interdisciplinary rounds were critical. Currently, between 1 p.m. and 2 p.m., the teams will round at the bedside. The hospitalist, the resident, the care manager, the social worker, and the nurse participate. We go around at the patient’s bedside to answer four key questions. The first question is, why is this patient here? The second is, why is this patient still here? The third is, what has to happen for this patient to leave the hospital? The last question is, where and when will this patient be discharged safely?
PV: How self-sustaining is this? Does this still need to be prodded and pushed or has it become automatic now?
KH: It’s definitely ingrained into our culture. When the care managers and social workers identify, along with the team, a discharge the day before, we put that in a computer program, and an email goes out to pretty much the entire medicine service and other services on a twice daily basis.
PV: Any pockets of opposition?
KH: The house staff had a small pocket. I think that we could have done a better job, perhaps, explaining the “why” to the house staff. The house staff constantly is rotating.
PV: Any steps going forward to further your progress?
KH: We’re moving to a slightly different metric to capture our early discharges. We’re gravitating to a median discharge time number. We’ve found that there’s sort of a flurry of activity that occurs between 9:30 a.m. and noon where people are really trying to rally to get patients out, but we want to level the load a little bit. We want to avoid the dichotomy of 11:59 a.m. is a good discharge time, but 12:01 p.m. is a bad discharge time, so we’re making a new metric called the median discharge time. The thrust of this new metric is, it’s OK if you didn’t make the 12:01 p.m. cutoff, but try and make every discharge as early as it can be. That’s really the message.