1412 Understanding and observing the ward round and discharge process time cycle to expedite the discharge process

Abstract

<h3>Aims</h3> To investigate impediments in the discharge process and ward round efficiency within a general paediatric ward for future flow and discharge improvement. <h3>Methods</h3> During a 6-month seconded post as the paediatric patient discharge and flow lead nurse shared between two hospital sites, cycle time observation was used to establish a quantifiable timeline of tasks within the ward round process. A total of three ward rounds were observed across both sites with either a paediatric consultant or registrar. Secondly, cycle time observation was utilised during the discharge process to establish a quantifiable timeline from ‘decision to discharge’ to when the patient left the ward area. A data collection tool was established to guide senior ward nurses in collecting data required during the discharge process. The data were collated into similar discharge patient groups: required a discharge letter only; required a discharge letter and TTAs (medication to take home); and required to meet a medical prerequisite prior to discharge and no TTAs, (e.g. patient required nap with good oxygen saturations). <h3>Results</h3> During the ward round observations, the main process for each patient review included: review of patient chart; discussion with family and patient assessment; and patient plan. Within hospital A, the average review of the patient was 22.2 minutes (12-27 minute range), and an average wait time between patients was 9.3 minutes. Within hospital B, the average review of the patient was 10 minutes (6-14 minute range), and an average review wait time between patients was 5.3 minutes. Majority of wait times were due to interruptions from other multi-disciplinary team members, access to patient files (including technology issues) and bedside teaching. Within the discharge process observation, discharges took 4 to 5.5 hours in total on average, dependent on the requirements of patient needs. Discharges with medical prerequisite experienced the longest discharge process. On average the medical team took 2.5 to 3.5 hours to complete the discharge letter or TTA order. The average time between letter completion and TTAs on the ward was 1.25 hours. Families averagely took 0.7 to 2 hours to leave the ward. Typically, the decision to discharge was late on the day shift, ranging from 11:00 to 12:40 on average. <h3>Conclusion</h3> Significant improvements could be implemented to streamline the efficiency of the ward round. In view of the observational results recommendations included: organisation of patient notes prior to ward round; uninterrupted ward round; and as the longest wait for patients was discharge paperwork, early commencement of discharge summaries the afternoon prior to expected discharge was suggested. Furthermore, initiating the ward round earlier would further impact the time when patients are discharged. Further cycle time observation is required to identify whether interventions surrounding ward round have caused improvement for more timely patient discharge, providing a more streamlined service and patient experience.