Abstract
Background In Hamad General Hospital, Acute Medical Assessment Unit 1, the discharges within 2 hours of the discharge order are at 60%. This indicates significant room for improvement in terms of streamlining the discharge process. The inefficiencies can result in delays, increased length of stay, patient dissatisfaction, and increased healthcare costs.1 2 A study found that between 8 and 10% of beds in an acute care hospital were occupied by patients whose discharge had been delayed.3 The aim of this quality improvement project was to increase the percentage of patients discharged within 2 hours of discharge order in Hamad General Hospital Acute Medical Assessment Unit 1 from about 60% in July 15, 2023, to 75% by December 31, 2023.
Methods Over 13 weeks, the improvement team worked towards the aim of increasing the percentage of patients discharged within 2 hours of discharge order. Change ideas utilizing the Plan-Do-Study-Act (PDSA) methodology were tested: (1) Awareness and Education Sessions (September 1–14, 2023); (2) Efficient flow lounge utilization (September 15–30, 2023); (3) A weekend discharge team that oversees and directs discharges on weekends (October 1 to November 4, 2023); and (4) the last PDSA running was flow lounge utilization after 2 p.m., from November 5, 2023 onwards.
Results The discharges within 2 hours of discharge order significantly increased from 60% to 97% by December 31, 2023 (figure 1). Concurrently, flow lounge utilization increased from 39% to 93%. As a result, the availability of beds for admission by 2 p.m. increased from 8% to 15%.
Conclusion The discharge timeliness significantly improved through awareness and active staff engagement, efficient utilization of Flow Lounge, and a dedicated Weekend Discharge Team. The discharge timeliness provides an opportunity to improve patient flow by having the capability to accommodate pending admissions in the Emergency Department.
Percentage of patient discharge within 2 hours of discharge order
Percentage of flow lounge utilization
References
Garcia A, Turner S, Pizzo E, Hudson E, Thomas J, Raine R. (2017). Impact and experiences of delayed discharge: a mixed-studies systematic review. DOI: 10.1111/hex.12619
Rohatgi N, Kane M, Winget M, Sheikhi F, Ahuja N. (2018). Factors Associated with Delayed Discharge on General Medicine Service at an Academic Medical Center. DOI: 10.1097/JHQ.0000000000000126
Stein H, Dun KS, Sepulveda J. Discharge planning assessment tool. American Nurse Journal 2023;18(6). doi:10.51256/anj062314
Ethical Approval/IRB Statement This Quality Improvement study was approved by the leadership of the Acute Medical Assessment Department at Hamad General Hospital, Doha, Qatar.
Disclosures and Acknowledgements The authors have nothing to disclose.
