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ACEP Now: Vol 38 – No 10 – October 2019Figure 1: Key Elements of UHS’s Power Through! Plan
Rollout of this program included a retreat that helped to articulate unit level discharge processes, discharge communication, discharge rounds, and tools to support the work. Figure 2 is a sample swim lane diagram articulating the discharge process on a typical unit.
Figure 2: Sample Swim Lane Diagram of the Discharge Process
The Results
The hospital at-large and the adult services unit performed particularly well (see Figure 3). This project was driven by nursing leaders Nelson Tuazon, assistant chief nursing officer, and Missam Merchant, director of the central operations management group. Note the dramatic increase in early discharges.
(click for larger image) Figure 3: Discharge Before Noon Trends for University Hospital and Its Adult Services Unit
The effect of early inpatient discharge on ED boarding is impressive (see Figure 4). By initiating discharge momentum earlier, beds opened up for ED admissions, which begin late in the morning and continue throughout the day.
(click for larger image) Figure 4: Trends in Discharge by Noon in the Adult Services Unit
At UHS, boarding had been difficult to manage. The increased DBN project had an immediate effect. This nursing-led inpatient project had the support of the dean, the medical school chairs, and the hospital leaders. With everyone aligned with the mission, they recovered wasted capacity without spending a penny on new inpatient rooms. The hospital has improved on its boarding problem so effectively that the emergency department has consistently avoided diversion for the past six months.
The take-home message is there are boarding solutions out there if your hospital is willing to Power Through!
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