General medical unit experience on Sunday physician led onsite discharge ward round

Abstract

The study aimed to report the characteristics and outcome of Sunday physician led onsite discharge ward round (SPLODR). We also look at the cost effectiveness of the process. The study was conducted over 15 weekends starting from 30 May to 10 September 2015 (winter period). It covered all sites where medical cases were located. The number of weekend discharges initiated by the Sunday onsite physician was recorded. The immediate past 15 weekends (15 February till 24 May 2015) were used as a control. SCGH weekly General Medicine (GMED) Dashboard statistics were used to compare the two periods. Patients in the study period were categorised into two groups according to the duration of stay in the GMED wards. Group A patients are those coming from Medical Admitting Unit (MAU) for less than 24 h. Group B forms the rest of the patients. We look at the number of discharges, complaint cases, reasons for failed discharges, time spent, issues encountered and cost analysis. There were a total of 28 cases of Sunday discharges in the study period versus 16 in the control period (P < 0.108). Only 7 out of the 28 cases (1 in every fortnight or 25%) are contributed by SPLODR. 2 out of 7 patients are from Group A and the rest come from Group B. Overall, there was no difference in the number of weekend discharges between the two periods (P < 0.09). The average time spent by the physician is 118.5 min. There were 14% (1/7) complaint cases. 12 out of 27 (44%) of the main cause of failed discharges is still because of unstable medical state followed by unavailable discharge destination, 19% (5/27); lack of allied health support, 15% (4/27); awaiting other specialist review, 11% (3/27); concerns from patient's family members, 7% (2/27); and lack of transport, 4% (1/27). No discharge summary for patients was the main issue encountered in the study period. The saving for early discharge is $7188.32 compared to an expenditure of $43 235.85 (weekend physician fee) in the SPLODR’s study period. There was a general increase in the number of discharged cases in the SPLODR. However, the number of discharges contributed by the physician onsite is much less than the pre-planned Sunday discharges by individual medical units (25% vs 75%). Majority of the discharge cases are from patients who have been in the medical unit longer. Cost and benefit analysis is not in favour of SPLODR. It costs taxpayer $6.0 in order to save a dollar. Besides medical reason for failed discharges, unavailable discharge destination and lack of Sunday allied health support are the obvious correctable factors contributing to failed Sunday discharges.