SHM Converge Scientific Abstract ePoster Gallery-Improving Discharge by Noon for Hospital Medicine Patients Utilizing a Provider Discharge Coordinator

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This quality improvement project tested whether adding a provider Discharge Coordinator (DisCo) could improve discharge-before-noon (DBN) rates for hospital medicine patients going home. The work was motivated by historically late discharges, which contributed to bottlenecks, and by additional COVID-19-related pressure to improve discharge efficiency and safety.<br /><br />A multidisciplinary team of hospitalists, nurses, social workers, case managers, and pharmacists used process mapping and stakeholder interviews to identify barriers to early discharge. Key needs included early communication with patients about discharge timing, transportation planning, and advance preparation of paperwork and prescriptions. Based on this analysis, the team created a pilot DisCo role staffed by a hospital internal medicine advanced practice provider.<br /><br />The DisCo supported discharge preparation by visiting patients to review the discharge plan, preparing paperwork and prescriptions, and completing other discharge-related tasks requested by the primary team. Assistance was categorized as either direct (face-to-face) or indirect.<br /><br />The intervention period (June 1 to July 31, 2020) was compared with a pre-intervention baseline (January 1 to March 31, 2020). Overall, DBN rates among all home discharges did not change significantly (14% pre-intervention vs 15% during intervention). However, among the 173 patients who received DisCo support, DBN was higher than in those without DisCo help (21% vs 14%). Direct DisCo visits were associated with the best results: DBN was 28% with direct assistance versus 15% with indirect assistance. Average discharge time improved only slightly overall, but improved by 39 minutes for DisCo-assisted patients and by 73 minutes for those who received direct DisCo visits.<br /><br />The authors concluded that the DisCo was helpful when it directly engaged patients and families, with positive informal feedback from patients and appreciation from primary teams. Its impact may have been greater with broader direct involvement.

Asset Subtitle

Jenna M. Jacobson

Meta Tag

Author List Gina Miller, Holly A. Schenzel, Jenna M. Jacobson, Jennifer Kleinman Sween, Ragaisis Taryn, Sagar Dugani, Trevor Coons

Category Research

Concept Discharge Coordinator

Concept Hospital Discharge

Concept Discharge Before Noon

Concept Gap Analysis

Concept Discharge Notification

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Jenna M. Jacobson

Track Quality Improvement

Keywords

discharge-before-noon

hospital medicine

discharge coordinator

quality improvement

COVID-19

patient discharge

process mapping

advanced practice provider

direct patient engagement

discharge efficiency

Discharge Coordinator

Hospital Discharge

Discharge Before Noon

Gap Analysis

Discharge Notification