Discharge When Medically Ready

Quality Problem: The timing and pace of patient discharges are not level-loaded throughout the day at many institutions including ours, an academic medical center and adult Level I trauma center located in Milwaukee, Wisconsin. Initial Assessment: Only 4% of patients were being discharged with rooms marked dirty by 11 AM at our institution. Choice of Solution: We put together a multidisciplinary team of approximately 30 stakeholders to develop a revised process that focused on coordination of discharge activities, plan of care awareness among team members, and communication with patients and families. Implementation: The discharge process was piloted and iteratively adjusted on a single medicine floor. Evaluation: Our interventions made a noticeable impact on median room “ready to be cleaned” (RTBC) time without having an adverse impact on length of stay. RTBC improved by a median of 39 minutes (P = 0.019), and the proportion of rooms ready to be cleaned by 11 AM increased from 4.19% to 8.13%. Lessons Learned: Having a multidisciplinary team participate in the evaluation and development of a new process was critical. Additionally, implementing solutions on a single unit allowed for rapid iteration of changes.