I’m not breaking any new ground when I say that improving hospital patient flow is really, really hard. Several months ago, I wrote about the challenges in improving observation patient management. (You can now see the recent outcomes of that work here!) I’d like to expand those ideas to tackle a thornier problem: inpatient discharge management.
Those on the front lines know the problem all too well: It’s daunting to navigate the everyday meetings, calls, texts, emails and conversations and while still understanding the next important thing to do, especially while using paper as your main tool. As a patient, you may have felt this too: a doctor or nurse comes by to see you in the morning and tells you that you’ll be going home soon, but you don’t actually get to leave until 3 or 4 p.m. Nobody’s plotting to keep you there longer than expected; it just takes a lot of coordination today by some amazingly dedicated people.
Tackling observation management is a great start because it’s more manageable out of the gate: working with a smaller set of patients that produces tangible results. But how do you prioritize hundreds of inpatients every single day to drive the best outcomes? It’s a “boil the ocean” problem. From an operations standpoint, you want to avoid capacity and boarding issues tomorrow. From a financial standpoint, you want to reduce the burden of “excess days” or “avoidable days”—the additional lengths of stay that directly result in a revenue hit. You also of course want to keep patients satisfied and healthier by not making them wait all day to go home, and by not making them wait in emergency departments and PACUs to get into your hospital.
This sounds impossible. But in the end, the old “people, process and technology” adage still applies, and it works. The twist in 2019 is that the technology now exists to take a greater role in driving what those people and those processes can achieve.
People. Hospitals often already have the staff they need to revolutionize inpatient discharge management, and many facilities are using Hospital IQ’s staffing tools to ensure this. There doesn’t necessarily need to be some person in a captain’s chair giving orders all day, every day. What hospitals do need, of course, is the will of executives to drive change and measure results.
Process. The Institute for Healthcare Improvement does a great job of laying out process needs, and I highly recommend checking out their whitepaper on the subject. Vital process keys to patient flow improvement include:
- A throughput steering committee
- Daily throughput huddles
- Multidisciplinary care team rounds
The good news is that most U.S. hospitals in 2019 do these things in some form. The problem is that all but the smallest hospitals still run into that “boil the ocean” problem daily, not having the tools to sharply focus their daily work and understand which individual patient discharges will have the greatest impact for both the patient and the hospital. This leads to things like less effective huddles that are merely readouts of current state rather than a focus on the work to do today, which then cascade into less effective rounds that don’t include much focus on discharges.
Technology. Here’s where that executive drive and those processes become game-changing reality. Hospital management and care teams are mobile, asynchronous and fast. They need technology that serves the process, not the other way around – nobody’s got time to print out reams of lists, or manually assemble a bunch of reports, or dig through 50 patient charts in an EMR. Discharge improvement efforts flounder not because hospitals don’t want to improve, but because it’s really hard to answer the question “What exactly should we do today?” The technology now exists to help hospitals cut through the noise and communicate daily priorities at the individual patient level clearly across all groups. This includes
- Centralized, actionable information culled from several different systems to end the hassle of gathering data and transform huddles into proactive discharge planning sessions
- Intelligence to automatically suggest the most impactful individual discharges for the day: not only patients who are at or near readiness to discharge, but also those discharges that will help solve tomorrow’s capacity problems based on census and throughput forecasts
- Fast, flexible tools to communicate and drive those priorities into rounds wherever they are, allowing teams to watch discharge progress in real time and collaborate on care plans even if they’re not in the same place
- Automated, targeted, drillable analytics to inform the throughput steering committee of progress on key performance indicators and areas for improvement
Hospital IQ’s AI-driven platform fuels huddles and rounds by taking the guesswork out of planning today’s most impactful actions at the individual patient level and allowing care teams to focus on what they do best. The combination of people, process and technology has always been a powerful one. With the automated intelligence and mobility that today’s technology brings, hospitals can achieve true and sustainable improvement to patient flow by focusing on the most impactful discharges at the right time.
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