Discharges Before Noon Improve Satisfaction, Contribute to Growth
Early discharges and transfers to non-acute care facilities are proven contributors to BWH efforts to reduce patient length of stay. Timely discharges and transfers are tied to BWH’s plans to grow inpatient volume and, as patients’ last impression of the hospital, play a major role in patient satisfaction.
“Plans for patient discharge really need to start before a patient is admitted,” said Michael Gustafson, MD, MBA, BWH’s vice president for Clinical Excellence. “And these plans should be finalized the day before discharge.”
In the last fiscal year, BWH saw a 1 percent reduction in length of stay to 5.49 days per patient and a 1 percent increase in inpatient volume. BWH averages between 100 and 125 discharges per day, and there are weeks when the average daily discharge reaches 135. Less than 15 percent of patient discharges, however, happen before noon.
In order to meet growth goals for this year and next, care teams must work towards morning discharges to free up inpatient beds for the next admissions. This is important for transfer-in cases as well, since facilities looking to refer a patient to BWH begin calling before 9 a.m.
“The worst time to accept transfers is late afternoon or early evening when we have the fewest staff to work up what are often complex transfers,” Gustafson said. In addition, late transfers have a negative effect on quality of life for attending and house staff.
Attending physicians should review discharge plans with members of the care team, including house staff, nurses and care coordinators during rounds in the morning and at the end of the day.
“When a patient and family plan on discharge in the morning, and then wind up waiting around all day, we’re sending them home with a negative last impression,” Gustafson said. With patients and families making arrangements for transportation home or to another facility and patient education involved at discharge, best practice is for the care team to begin planning for a specific discharge time the day before.
For many patients, there are viable alternatives to admission to or remaining at BWH within Partners HealthCare System. The Boston Center for Rehabilitative and Sub-acute Care provides interim nursing care from hospitalization to home. In a recent patient satisfaction survey, 35 of 35 patients/families said that they would refer a family member to the Center based on their own experience. The Boston Center provides physical, occupational and speech therapy and rehabilitation services for orthopedic, vascular, pulmonary, cardiac, complex medical and neurological patients.
Additional alternatives include Spaulding Rehabilitation Hospital and Youville Hospital and Rehabilitation Center. Spaulding services are available to patients who can undergo significant rehabilitation for strokes and complex or multiple joint replacements, or after acute illness. Youville has a proven track record in caring for complex medical and surgical patients who are on ventilators and intravenous medications and those requiring significant medical care. BWH Pulmonary physicians and MGH Oncology physicians see patients at Youville, which has telemetry beds. Dialysis patients can be cared for at both Youville and Spaulding.