PV: What was the afternoon like before this process?
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ACEP Now: Vol 35 – No 12 – December 2016KH: Our interdisciplinary rounds were critical. Currently, between 1 p.m. and 2 p.m., the teams will round at the bedside. The hospitalist, the resident, the care manager, the social worker, and the nurse participate. We go around at the patient’s bedside to answer four key questions. The first question is, why is this patient here? The second is, why is this patient still here? The third is, what has to happen for this patient to leave the hospital? The last question is, where and when will this patient be discharged safely?
PV: How self-sustaining is this? Does this still need to be prodded and pushed or has it become automatic now?
KH: It’s definitely ingrained into our culture. When the care managers and social workers identify, along with the team, a discharge the day before, we put that in a computer program, and an email goes out to pretty much the entire medicine service and other services on a twice daily basis.
PV: Any pockets of opposition?
KH: The house staff had a small pocket. I think that we could have done a better job, perhaps, explaining the “why” to the house staff. The house staff constantly is rotating.
PV: Any steps going forward to further your progress?
KH: We’re moving to a slightly different metric to capture our early discharges. We’re gravitating to a median discharge time number. We’ve found that there’s sort of a flurry of activity that occurs between 9:30 a.m. and noon where people are really trying to rally to get patients out, but we want to level the load a little bit. We want to avoid the dichotomy of 11:59 a.m. is a good discharge time, but 12:01 p.m. is a bad discharge time, so we’re making a new metric called the median discharge time. The thrust of this new metric is, it’s OK if you didn’t make the 12:01 p.m. cutoff, but try and make every discharge as early as it can be. That’s really the message.
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One Response to “Early Hospital Discharge Can Improve Capacity, Patient Flow”
December 1, 2022
Mark BThis is ridiculous. The inpatient/hospitalist team controls discharges, and they are trying to get patients out. I am a cardiologist but worked as a hospitalist during and for months past COVID. Everybody wants to discharge. Administration is looking at everyone of your patients and saying about your patient who had two rapid responses overnight “Well these haven’t had one this morning, can they be discharged.” The patients want to leave. They can have two chest tubes in and as your rounding on them they say”can’t you pull these out and I can go home”. Hospitalists make more on discharges than progress notes, so they are trying to discharge their service. But the hospitalists are generally short term employees and so are the dumping ground for the whole hospital. Let hospitalists actually do their job and not be the answer for everything the hospital doesn’t want to deal with. The ER contributes to this issue. If a patient is a true ICU patient and the ICU initially denies, sending them to the floor is not the answer. Spending three hours straight with one patient, you are not going to be able to discharge your other 19 patients. You don’t call to admit a severe nose bleed, then the hospitalist gets down their and the patient is on anticoagulants, has a SBP of 255, and a severe headache. So you are in the ER getting down the BP and ordering a head CT to make sure their is no bleed. The patients need to be reasonably stable. But the hospitalists are quoting. I would estimate over 75% of my shifts we were down at least one hospitalist, which means you are carrying too many patients to just discharge. And the hospitalists are getting worked dumped on them that should not be theirs from all directions. I will never do the job again and most of the hospitalists I worked with are looking for different careers. As their is a hospitalist shortage and I have just gotten two calls in the last hour about opening because their is a shortage, plan on boarding to get worse. We need to discharge more. Thanks for the rocket science.