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Discharge Best Practices
Discharge best practices serve as the foundation for systematic, effective patient flow. Expected, planned, coordinated and completed patient discharges:
Improve patient care
Increase satisfaction
Creates stability in hospital capacity.
Best Practices
Promote accuracy of patient’s discharge 24 hours in advance to ensure planning and completion of contingent needs and timely discharge. To do this:
Enter Pending Discharges 24 hours in advance of the actual discharge to improve discharges before 11am and 2pm for patients who are clinically ready.
Review Confirmed Discharges the day of discharge by acknowledging interface with physician order. Without interface, based on the actual written order, the nurse /unit clerk will enter the Confirmed Discharges indicating the patient is going home the current day with no contingencies.
Ensure Projected Discharge date/time is entered and updated as needed 24 hours in advance.
Initiate Discharge Milestone Delays and comments during daily multidisciplinary rounds and throughout the day. When a delay is identified and a patient is not ready for discharge within 120 minutes of the confirmed discharge, communication of the discharge delay is necessary.
Utilize Discharge Timer and Alerts to visualize discharge delay reasons for process improvement opportunities.
Ensure bed is dirtied in real-time upon the patient’s actual discharge to create capacity earlier in the day. To do this:
Ensure bed is dirtied in real-time upon patient’s actual discharge using the following methods:
Auto-Discharge
Transport
Organize EVS to manage peak times, shift changes, and ensure consistent and efficient cleaning of beds 24/7. To do this:
Continuously monitor and adjust EVS to manage peak times and shift charges by defining and reviewing prioritization and zoning to improve bed availability.
Create dedicated discharge SWAT team with staggered start times to match dirty bed pattern.
Maintain a consistent shift change procedure to ensure no disruptions of cleaning beds:
Housekeepers will log in and out for each shift.
Supervisors verify that the all housekeepers are logged in to the correct zones, with a pager or mobile device.
Schedule overlapping shifts to ensure that bed cleans continue during shift change. • Supervisors reassign dirty beds at shift change to new staff.
Define prioritization processes for most efficient cleaning routes to improve bed availability.
Establish work priority order and expected responses. Keep priorities displayed to ensure that all employees know the priorities. Examples of priorities and targets include:
Stat Clean (10 min max response)
Clean Next (20 min max response)
Discharge Clean (30 min max response)
Daily Clean
Daily Cleans for Pending Discharges
Daily Cleans for Confirmed Discharges
Prioritize dirty beds over the daily/routine cleans to improve bed turn times.
Establish clear criteria for bed status determination - Stat and Clean Next. Only Patient Placement / House Supervisor should have the ability to change bed status.
Leverage technology and automation for immediate notifications and escalations to improve resource efficiency and bed turns.
Utilize the suspend feature when using a 2 step cleaning process (such as when using a Xenex machine for isolation room cleans). Beds are only marked clean when they are ready to receive the next patient.
Ensure Supervisors are logged in to receive alerts, notifications and no coverage pages to improve bed turnaround times.
Provide EVS Supervisors with PreAdmit console in order to plan for projected discharge and transfer volume.
Pending/Confirmed Discharges
Projected Census
Bed Board
List of all bed requests, without patient names
Housekeepers should not be permitted to login to the computer application. This should be reserved for Leads, Supervisors, and Managers.
Utilize the suspend feature when using a 2 step cleaning process (such as when using a Xenex machine for isolation room cleans).
Beds are only marked clean when they are ready to receive the next patient. Ensure Supervisors are logged in to receive alerts, notifications and no coverage pages to improve bed turnaround times. Provide EVS Supervisors with PreAdmit console in order to plan for projected discharge and transfer volume. • Pending/Confirmed Discharges • Projected Census • Bed Board • List of all bed requests, without patient names. Housekeepers should not be permitted to login to the computer application. This should be reserved for Leads, Supervisors, and Managers.
Notify Nursing Unit of delayed beds on their pager/screen alert and also the Nursing Supervisor. Nursing has to hold the responsibility to release the delay bed back to dirty when appropriate to minimize the delay time.
POTENTIAL OBSTACLES & CONSIDERATIONS
Potential Obstacle: Ensure Transport and EVS Departments are optimally staffed per shift to complete the discharging of patients and to meet the discharge demand cleans.
Considerations
Know peak demands for service and adjust staff accordingly.
Consider staggering employees work schedule to meet the demands.
Utilize data to ensure workforce is sufficient.
Review the time on task for transporters, when the demand for jobs is high, compared to the number of staff throughout the day.
Evaluate when beds dirty, and peak levels to compare staffing levels - not just those cleaning rooms, but additional EVS staff assigned to clean other areas throughout the hospital.
Ensure EVS and Transport are included in the Patient Flow Governance Council Structure.
Consider temporary workforce if all other means have been exhausted.
Potential Obstacle: Ensure discharge orders are written early enough to meet discharges by 11AM and 2PM.
Considerations
Collaborate with physicians to ensure they are rounding at ideal times in order to write discharge orders earlier in the day.
Ensure physicians are writing early discharges prior to starting teaching rounds.
Potential Obstacle: Case Management should utilize the system because of the importance of their role in discharging patients for system wide transparency.
Considerations
Establish the frequency of updating the Projected Discharge Date either in TeleTracking or the ADT system, assuming it’s interfaced, to ensure accuracy and transparency of discharge information.
Begin multi-disciplinary planning for early discharges the prior day to avoid delays in discharge.
Involve case management in leading multi-disciplinary huddles to ensure that teams are aligned with patient discharges.
Ensure case management is involved/ assisting nursing in updating pending discharges, projected discharge date and milestones to ensure timely discharge.
Potential Obstacles: Discharge Transportation Arrangement
Considerations
Look at Lab Turn around time with a goal of Order to Result in < 45 minutes.
Ensure alternate transportation providers to meet the needs of timely patient discharges.