Improving before-noon discharges in the acute medical ward

Abstract

Background: Mismatch in admission and discharge rates with poor coordination of bed availability to prepare for peak admission time do not favor patient flow in any healthcare situation. In order to meet the admissions demand from the emergency department, early discharge is advocated. Aim: The purpose of this study was to increase the 11:30 discharge rate in the acute medical ward to 20% within 5 months in order to facilitate patient transfers from the emergency department. Method and intervention: A nurse-led multidisciplinary team discussion at 10:00 was formed empowering nurses and aims to prioritize early discharges or transfer patients who require a longer stay in the hospital. The indication of expected discharge date was determined by team doctors on either day 1 or 2 of admission, to facilitate and prioritize allied health intervention or even prescription processing. Physical transfer to the discharge lounge was to occur earlier, awaiting preparation of prescription and documentation. Dedicated nursing staff who manage the discharge lounge processes, were to ensure the transfers and care arrangements to be smooth and coordinated with enhanced communication to next of kin. Results: The overall median rate for discharges before 11:30 in the acute medical ward was at 17%, compared to baseline median discharge rate of 12% ( p=0.05) and evening discharges that remained. With the implementation of a framework for multidisciplinary team discussion, the mean time spent on multidisciplinary team reduced to 40 min from the pre-intervention stage, ranging approximately 57–68 min. Conclusion: The discharge process is complex and requires multidisciplinary team collaboration and coordination. This project also created an opportunity for more relevant project targeting evening discharges that addresses another emergency department peak admission time.