SHM Converge Scientific Abstract ePoster Gallery-Utiliziation of Discharge Delay Entry: An Interdisciplinary Quality Improvement Initiative to Assist in Hospital Flow

Pdf Summary

This quality improvement project aimed to improve documentation of Medically Ready for Discharge Date (MRDD) and Discharge Delays (DDs) in the EMR on a 26-bed medicine unit. Initially, only 2.6% of patients discharged after being medically ready had a DD entered, despite many patients meeting MRDD criteria. The team used repeated Plan-Do-Study-Act (PDSA) cycles with interdisciplinary communication, including resident and faculty education, weekly emails, in-person reminders, and a “soft force function” in the EMR that added MRDD and DD columns to senior resident patient lists.<br /><br />The project’s original SMART aim was to raise DD documentation to 10% between November 2023 and September 2024. This target was exceeded early, with documentation peaking at 24% in February 2024 and remaining above goal thereafter, despite a temporary decline in July 2024 due to learner turnover. The most effective intervention was the EMR workflow change, which served as a daily visual reminder and made data entry easier.<br /><br />Common discharge barriers identified included skilled nursing facility placement issues, especially bed availability (39%), disposition changes such as unsafe discharge (15.5%), consult-related delays, particularly physical therapy (11.6%), and imaging delays, including echocardiography and MRI (8.1%). These findings were shared with senior leadership to support broader hospital flow improvements.<br /><br />The team plans to expand the project by incorporating equity-focused analysis, stratifying discharge delay data by age, race, and social vulnerability index (SVI). Preliminary observations suggest patients with higher SVI may have longer lengths of stay, but more data are needed to determine whether disparities exist.

Asset Subtitle

Kavya Bana

Meta Tag

Author List Kavya Bana, Meghan Train, Nina Rizk

Category Research

Concept Better Flow Program

Concept Medically Ready for Discharge Date

Concept Discharge Delay

Concept Discharge Delay Documentation

Concept ED Throughput

Distinguished Non-Finalist

Presenter Organization University of Rochester Medical Center

Presenting Author Kavya Bana

Track Quality Improvement

Keywords

Medically Ready for Discharge Date

MRDD

Discharge Delays

EMR documentation

quality improvement

PDSA cycles

interdisciplinary communication

soft force function

hospital flow

health equity

Better Flow Program

Medically Ready for Discharge Date

Discharge Delay

Discharge Delay Documentation

ED Throughput