Patient Discharge Process Research Articles

Challenges Facing Heart Failure Patients With Limited English Proficiency: A Qualitative Analysis Leveraging Interpreters’ Perspectives

BackgroundLimited English proficiency (LEP) heart failure (HF) patients experience worse HF outcomes, including higher readmission rates and emergency department visits. To elucidate the challenges this population faces, the authors interviewed interpreters to identify gaps in care quality and ways to improve care for LEP HF patients. ObjectivesThe authors sought to understand the challenges facing HF patients with LEP using medical interpreters’ perspectives. MethodsThe authors conducted a qualitative study using semistructured interviews with interpreters working at an academic medical center. All interpreters employed by the medical center were eligible to participate. Interviews were analyzed using thematic analysis. ResultsThe authors interviewed 20 interpreters from 9 languages (mean age: 48 ± 14.3 years; mean experience: 16.3 ± 10.6 years). Two themes regarding the challenges of care delivery to LEP HF patients emerged: 1) LEP patients often had a limited understanding of HF etiology, prognosis, and treatment options, and interpreters cited difficulty explaining HF given the complexity of the subject; and 2) practical steps to improve the discharge process for LEP HF patients. Integrating interpreters into both the inpatient and outpatient HF teams was a strongly supported intervention. Additionally, conducting pre-encounter huddles, providing the interpreter service phone number at the time of discharge, involving family members when appropriate, and considering nutrition referrals were all important steps highlighted by interpreters. ConclusionsThis study illuminates challenges that LEP HF patients face and provides potential solutions to improve care for this vulnerable group. Integrating interpreters as part of the HF team and designing practical discharge plans for LEP HF patients could reduce current disparities.

“We don't have a good system for people who don't have a home and don't need a hospital”: Contextualizing the hospital discharge process for people experiencing homelessness in Toronto, Canada

Hospital discharge is a key transition in a patient's care pathway, providing an effective point of intervention to address a patient's ongoing health and social care needs. Addressing these needs may prevent hospital readmissions. The hospital discharge process for people experiencing homelessness who have been admitted for medical conditions has not been well-characterized. To address this gap in knowledge, we interviewed hospital and shelter workers, and key informants, about their experiences when unhoused patients are discharged from hospitals to shelters. Using critical realism, we explored the organizational and service context of this process by looking at the relationship between structures and agency in the daily work of our participants. Our results indicate that the discharge process for unhoused patients was shaped by two systems failures, barriers to publicly funded systems including community resources, and silos and gaps between these systems, ultimately leading to failed transitions to the community. The most prominent manifestations of these systems failures were a) limited and inadequate access to post-discharge care and services, b) barriers to accessing shelters, c) inadequate service integration between healthcare and social service sectors, and, d) poor cross-sectoral knowledge between hospital and shelter workers. We characterize the discharge process for unhoused patients as a part of a larger systems failure in the care for unhoused patients and contend that improvements in hospital discharges requires changes to underlying structures that lead to inadequate discharges.

A Study of the Causes of Delay in Patient Discharge Process in a Large Multi-Speciality Hospital with Recommendations to Improve the Turn around Time

On an average, around 25–30 discharges occur/day which includes cash and insurance patients. Approximately 45% are cash discharges and 55% are insurance discharges. This study deals with an analysis and evaluation of the delay in discharge process of cash and insurance patients once the discharge advice is given by the treating doctor. Methods of analysis include pareto analysis and descriptive statistics. The study draws attention to the fact that the average time taken for discharge of cash patients is 3 h and 57 min and for insurance patients is 5 h and 9 min that is a delay of 1 h and 41 min and 1 h and 23 min for cash and insurance patients, respectively. Results of the analyzed data show the delay in each process of discharge excluding the process of file sent to billing after discharge intimation is done by the nurse. Hence, improvement is required at each and every step involved in discharge process. Pareto analysis is used to prioritize the factors responsible for causing major delays and recommendations are given for the same. Most of the time was consumed in the process of bill preparation due to the delay in getting clearance from laboratory, pharmacy, and radiology department followed by finalization of discharge summary. Following are the recommendations based on the study:

Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru

ObjectivesTo understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru. MethodsA qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients’ journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis. ResultsWe conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services. ConclusionThe continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients’ experiences and feelings by developing solutions in a participatory manner.

Implementation of Electronic Patient Discharge: A Successful Strategy to Increase Hospital Bed Capacity During the COVID-19 Pandemic

Background: The ongoing COVID-19 pandemic increased the need for inpatient beds, indicating the need for hospitals to increase the efficiency of beds. Objectives: This study aimed to increase hospital bed capacity using the implementation of Electronic Patient Discharge (EPD). Methods: This qualitative-quantitative study was conducted in a tertiary care hospital using the pre-and post-intervention designs, and the main outcome was patient discharge time. By applying the Six Sigma model, including definition, measurement, analysis, improvement, and control, the patient discharge process was assessed and improved by some interventions such as EPD. All hospitalized patients with COVID-19 from 21 March 2020 to 22 July 2021 were examined for the post-intervention. In addition, data were collected from the hospital information system (HIS). Results: By the use of EPD, patient discharge time decreased to 47.70% (from 10.19 h to 5.33 h) (P < 0.000). According to the Sigma level, the yield and defects per million opportunities of the discharge process also increased to 55%. Conclusion: Six Sigma methodology can be an effective change management tool to improve discharge time to cover the demand created during pandemics. According to the results of the present study and the obtained saved time, one bed is added to the hospital capacity for every five discharges.

Examining the challenges of hospital discharge for patients with a urinary catheter.

Patient discharge between acute and secondary care will be viewed differently based on the stakeholder groups involved. Examining these different perceptions may help improve the discharge process and the patient journey from hospital to home. To determine the perceptions of community and hospital nursing staff regarding the challenges that exist with the general hospital discharge process for patients with a urinary catheter. A survey was created and sent to a wide range of acute and community nurses and the subscriber list of Journal of Community Nursing, Journal of General Practice Nursing and Wound Care Today. Compared with hospital staff, the opinions of community staff were more negative around the discharge process and post-discharge care and materials. Results of this survey provide insight into the perceptions of nursing staff into general patient discharge for those with a urinary catheter and help identify the challenges that exist on the patient journey from hospital to home.

Strengthening Hospital Capacity for the COVID-19 Pandemic: Implementation of Electronic Patient Discharge

Background: Increasing hospital capacity to cover the service demands is an important priority during an epidemic or a pandemic. The aim of this study was to increase hospital capacity using the Six Sigma method to improve the patient discharge process. Methods: This was a quantitative study. The Pre- and post-intervention study was conducted in a big hospital designated for COVID-19 patients. The patient discharge process was evaluated and improved based on seven sub-processes and following the Six Sigma model, including defining the problem, measuring time in each of the discharge stations, analysis times and process, improvement process, and control. Results: Implementation of the electronic patient discharge led to a 51.9% decrease in discharge time from 7.3 h during the pre-intervention period to 3.8 h post-intervention (P< 0.0001). According to the Sigma level, the yield and defects per million opportunities of the discharge process also improved to 55%. Conclusion: Increasing hospital capacity by improving the discharge time is a quick action to cover the demand created during pandemics. Also, about 32 beds can be obtained by applying the Six Sigma model to improve the discharge process in a short time and at a very low cost.

Prolonged Air Leak and Heimlich Valve

Objective: In this study, the effectiveness of Heimlich valve application in the treatment of prolonged air leak after surgery in patients who underwent lung surgery for any reason has been investigated. Materials And Methods: Thirty-three patients who had undergone surgery for various reasons in our clinic between June 2014 and December 2018 and developed prolonged air leakage were included in the study. The patients were called for control earliest on the third day after discharge to evaluate whether the Heimlich valve was used effectively. In the controls, a leak test was performed with plastic containers filled with 50 cc saline solution to evaluate the presence of air leaks. Results: Of the 33 cases included in the study, 22 men and 11 women. The average age was 50.3 years (range 20-72). Of the thirty-three patients, 13 were operated for bullous lung disease, nine for diffuse interstitial lung disease, four for lung cancer, four for empyema, two for nodular lung disease and one for hydatid cyst. The most common surgical procedures were wedge resection and bulla excision. The average postoperative period for taking Heimlich valve was 10.2 days (range 7-15 days). The procedure was considered unsuccessful in two (6.1%) cases. The success rate of the procedure was determined as 93.9%. Conclusion: We think that the Heimlich valve is an effective method in the treatment of prolonged air leaks after lung surgery, as it accelerates the patient's discharge process and improves the quality of life.

Building consensus on inpatient discharge pathway components in the management of blunt thoracic injuries: An e-Delphi study amongst an international professional expert panel

IntroductionAccess to a standardised and evidence informed approach to blunt thoracic injury (BTI) management remains challenging across organised trauma systems globally. It remains important to optimise recovery through pathway-based interventions. The aim of this study was to identify components of care that are important in the effective discharge process for patients with BTI and pinpoint core and optional components for a patient pathway-based intervention. MethodsComponents of care within the hospital discharge process after BTI were identified using existing literature and expert opinion. These initial data were entered into a three-round e-Delphi consensus method where round one involved further integrating and categorising components of discharge care from the expert panel. The panel comprised of an international interdisciplinary group of healthcare professionals with experience in the management of BTI. All questionnaires were completed anonymously using an online survey and involved rating care components using Likert scales (Range: 1-6). The final consensus threshold for pathway components were defined as a group rating of greater than 70% scoring in either the moderate importance (3-4) or high importance category (5-6) and less than 15% of the panel scoring within the low importance category (1-2). ResultsOf 88 recruited participants, 67 (76%) participated in round one. Statements were categorised into nine themes: (i) Discharge criteria; (ii) Physical function and Self-care; (iii) Pain management components; (iv) Respiratory function components; (v) General care components; (vi) Follow-up; (vii) Psychological care components; (viii) Patient, family and communication; (ix) ‘Red Flag’ signs and symptoms. Overall, 70 statements were introduced into the consensus building exercise in round two. In round three, 40 statements from across these categorises achieved consensus amongst the expert panel, forming a framework of core and optional care components within the discharge process after BTI. ConclusionsThese data will be used to build a toolkit containing guidance on developing discharge pathways for patients with BTI and for the development of audit benchmarks for analysing healthcare provision in this area. It is important that interventions developed using this framework are validated locally and evaluated for efficacy using appropriate research methodology.

Reducing failures in daily medical practice: Healthcare failure mode and effect analysis combined with computer simulation

This study proposes a risk analysis approach for complex healthcare processes that combines qualitative and quantitative methods to improve patient safety. We combine Healthcare Failure Mode and Effect Analysis with Computer Simulation (HFMEA-CS), to overcome widely recognised HFMEA drawbacks regarding the reproducibility and validity of the outcomes due to human interpretation, and show the application of this methodology in a complex healthcare setting. HFMEA-CS is applied to analyse drug adherence performance in the surgical admission to discharge process of pheochromocytoma patients. The multidisciplinary team identified and scored the failure modes, and the simulation model supported in prioritisation of failure modes, uncovered dependencies between failure modes, and predicted the impact of measures on system behaviour. The results show that drug adherence, defined as the percentage of required drugs received at the right time, can be significantly improved with 12%, to reach a drug adherence of 99%. We conclude that HFMEA-CS is both a viable and effective risk analysis approach, combining strengths of expert opinion and quantitative analysis, for analysing human-system interactions in socio-technical systems. Practitioner summary: We propose combining Healthcare Failure Mode and Effects Analysis with Computer Simulation (HFMEA-CS) for prospective risk analysis of complex and potentially harmful processes, to prevent critical incidents from occurring. HFMEA-CS combines expert opinions with quantitative analyses, such that the results are more reliable, reproducible, and fitting for complex healthcare settings.

Care transition from rehabilitation to home: A QI project using the RED Toolkit to decrease readmission rates

Objective: This quality improvement (QI) project’s aim was to lower 30-day healthcare reutilization for patients aged 50 or older with hip fracture using an evidence-based discharge process method, the Re-Engineered Discharge (RED) Toolkit.Methods: The QI project of a revised patient discharge process to lower healthcare reutilization of Baton Rouge Rehabilitation Hospital (BRRH) hip fracture patients was implemented as an evidence-based quality improvement initiative. Inpatient and outpatient discharge process revisions were implemented at an inpatient rehabilitation facility (IRF) based on Re-Engineered Discharge (RED) Toolkit recommendations. Inpatient revisions included patient barrier identification with associated documentation changes to the IRF interdisciplinary team form. Outpatient modifications consisted of an After-Hospital Care Plan (AHCP), and two post-discharge Telephone Follow-Up (TFU) calls.Results: Healthcare reutilization and thirty-day hospital readmission for this project were measured at 8.5% and 5.7%, respectively. A decrease in healthcare reutilization of at least 1.6% was observed for the IRF. Most participants scored at a high level (88.6%) of “patient knowledge of self-management” post intervention. Out of participants who did not attend their first Primary Care Provider (PCP) appointment, 33.3% experienced healthcare reutilization. This result emphasized the importance of seeing one’s PCP post-discharge. Patient satisfaction increased by 5% and 6.73%, measured by Hospital Consumer Assessment of HealthCare Providers and Systems (HCAHP) scores for nursing care and physician care, respectively.Conclusions: Implementation of a RED Toolkit-based discharge process at an IRF positively impacted all three study outcomes and associated healthcare costs in lowering preventable readmissions.

Implementation of an accelerated discharge process following percutaneous coronary intervention for patients with non-ST elevation acute coronary syndromes.

Historically, patients with non-ST elevation acute coronary syndrome (NSTE-ACS) are monitored as inpatients following successful percutaneous coronary intervention (PCI), but accumulating evidence demonstrates that accelerated discharge is safe, reduces cost, and enhances patient satisfaction. This quality improvement project examined the impact of implementing a post-PCI streamlined discharge process for NSTE-ACS patients on length of stay (LOS), major adverse cardiovascular events, and provider utilization at a university-affiliated hospital system. Clinical characteristics, the timing of admission, PCI, and discharge data were collected prospectively from patients presenting to the catheterization laboratory for intervention for NSTE-ACS during 90-day historical control and implementation periods. The knowledge to action implementation model was employed to establish a peer-coaching based educational tool for educating interventional cardiologists and inpatient clinicians regarding patients with low-risk characteristics suitable for same-day discharge (SDD) following PCI. Patient characteristics were similar between the historical and implementation periods. Although total hospital LOS did not decrease (51 ± 24 vs. 41 ± 18 h; P = 0.14), the discharge process reduced LOS after PCI among low-risk patients (22 ± 6 vs. 17 ± 8 h; P = 0.003). Complication and readmission rates were unchanged by SDD. Provider utilization of the discharge process increased four-fold during the implementation period (8% vs. 32%; P = 0.02). Implementation of an accelerated discharge process following PCI for low-risk NSTE-ACS patients reduced post-PCI LOS without increasing readmissions or complications. Increased utilization of the process throughout the implementation period may be attributed to peer coaching.

The use of clinical decision support in reducing readmissions for patients with heart failure: a quasi-experimental study

Background Heart failure is a chronic, progressive condition which affects over six million Americans and 26 million people worldwide. Evidence-based guidelines, protocols, and decision-support tools are available to enhance the quality of care delivery but are not implemented consistently. Aims To examine the effect of clinical decision-making support during patient discharge on 30-day hospital readmission among patients admitted with heart failure and evaluate provider utilization and satisfaction of clinical decision support tool. Design A quasi-experimental study. Methods An intervention group of hospitalized patients (N = 55) with heart failure were provided the intervention over a 3-month period and compared to the pre-intervention comparison group (N = 109) of patients who did not receive the intervention. An evidence-based discharge checklist and a pocket guide was implemented by an advanced practice nurse to assist health providers with clinical decision making. Descriptive statistics among samples, 30-day readmission rates, and provider utilization and satisfaction were examined. Results Readmission rates slightly decreased (N = 109, 9.2% vs. N = 55, 9.1%) in the post-intervention period, but no significant difference. Heterogeneity between the two groups were minimal related to use of specific medications, age, length-of-stay and comorbidities. Descriptively, there was a significant difference the use of diuretics among each group (p = .002).The discharge checklist was used regularly by 67% of (N = 15) providers, and 93% expressed satisfaction with use. Conclusion There was no significant reduction in 30-day readmission rates between both groups. However, a slight reduction was noted which indicates the need for further examination into how the use of checklists for clinical decision support can reduce readmissions. A well-designed evidence-based discharge plan remains a critical component of the patient discharge process. Advance practice nurses are uniquely qualified to implement evidence-based interventions that promote practice change among health care providers and improve health outcomes.

Reducing the Length of Stay by Enhancing the Patient Discharge Process: Using Quality Improvement Tools to Optimize Hospital Efficiency.

Delays in the discharging process can affect hospital efficiency. Improving patient flow in acute care hospitals is an essential issue that hospital management and research aim to achieve. Admission volume and LOS for hospitalized patients in the medical specialties department was examined at a tertiary care center in Riyadh, Saudi Arabia, to explore practical approaches to reduce the LOS. We aimed to identify and manage reasons for the delay in discharging patients from the medical specialties department at a tertiary care center in Saudi Arabia. Admission and discharge data for hospitalized patients were collected from 2016-2018. In 2017, a FOCUS (find, organize, clarify, understand, select)-PDSA (plan, do, study, act) quality improvement method was used to improve the discharge processes, with specific measurable targets per year. The number of readmissions and mortality rates decreased significantly after the intervention was implemented, suggesting an improvement in the quality of treatment and the process of admission and discharge. Despite gradual increases in admissions from 2016 to 2018, the mean LOS decreased significantly between 2016 and 2018, from 9.16 to 7.47 days (p < 0.001). The number of readmissions and mortality rates decreased after the intervention was implemented in 2017, suggesting an improvement in the process of admission and discharge. The LOS can be reduced by implementing a quality improvement intervention, driven by a multidisciplinary committee involving healthcare personnel, to facilitate the optimal discharge mechanism through available hospital resources and services.

&lt;i&gt;“The Patient is Practically Abandoned”.&lt;/i&gt; Challenges in Post-Stroke Care During the COVID-19 Pandemic in Peru”

Background: Stroke care after discharge is complex and usually involves several providers based at different health establishments. In low- and middle-income countries (LMICs), continuity of care is often compromised because of the fragmentation of the health care system which might have worsen during the COVID-19 pandemic. Our study aimed to 1) understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and 2) identify potential opportunities to improve these processes, while contrasting pre and during COVID-19 experiences in Peru. Methods: Qualitative study conducted between February and March 2021 that consisted of in-depth interviews of patients with stroke, their caregivers and health care personnel regarding stroke care at a referral center for stroke care in Lima, Peru. We explored the following phases of the patients’ journeys: pre-hospitalization, emergency room, hospitalization, discharge process and after discharge. For each phase, we explored experiences, feelings and expectancies using thematic analysis. Results: We conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred problems related to communication with health care personnel and an absence of training to provide care at home after discharge. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic health care records, improving the referral system and reinforcing telemedicine services. Conclusions: The continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact might have been greater due to the already weak and fragmented health care systems. The COVID-19 pandemic posits an opportunity to improve post stroke care services, and addressing patients’ experiences and feelings in developing solutions in a participatory manner is need. Funding: This study was funded by the Fogarty International Center (NIH Research Training Grant D43:TW009345) through the Northern Pacific Global Health Research Fellows Training Consortium. Declaration of Interest: None to declare. Ethical Approval: This study was evaluated and approved by the Institutional Review Boards of the University of Washington and INCN.

Lean Approach to Processes Regarding Nursing Activities at Hospital: Evaluation of Nurses’ Views

Objective: The study was planned to evaluate views of the nurses about lean approach to processes related to nursing activities.Methods: The descriptive study was conducted with 178 (71.2%) nurses selected from a total of 250 nurses working at six public hospitals in Artvin Province. The data were collected with a survey consisting of questions regarding the nurses demographic features and their views about lean approach to nursing activities at hospitals and then analyzed with percentages and chi-square tests.Results: In the study, 46.1% of nurses stated that the unit where they worked needed lean approach partly. The nurses with graduate degree supported this view more (p=0.034). These nurses stated that the activities to receive belongings of patients during patient admission (21.3%), to fill in patient discharge form during discharging process (16.4%), to perform the hygienic and other care applications of the patients and to record them on the nurse observation form of daily nursing activities (11.1%) were unnecessary. In addition, they explained that activities to shave patients before operation (9.4%) and to enter physicians’ orders by nurses into the system in laboratory process (13.5 %) and to in monitoring process (20.8%); to send all patient files to the pharmacy with the personnel for drug/device supply in pharmacy process (14.3%), were unnecessary. Conclusion: The unnecessary nursing activities were defined in the nursing processes regarding patient admission and discharge processes, daily nursing workflow, operating room processes and laboratory, monitoring, blood centre, pharmacy processes. It is recommended that these processes identified may provide lean approach by eliminating them.

Identifying Influential Factors of the Patient Discharge Process from ShafaTakestan Hospital in Qazvin City

Background:The process of the patient discharge from the hospital is one of the most important processes that has been taken into consideration by managers in recent years. An efficient health system can only accomplish its duty to provide the health of the community by providing the right services and this system can be evaluated through its services. Therefore, the necessity of performing this research is to improve the quality of hospital services for patients and increasing patient satisfaction. This study has been aimed to identify the factors affecting the process of patient discharge. Methods: This was a cross-sectional study conducted in a general hospital located in Takestan, Qazvin in 2019. The study population in the qualitative section of the study included those who were aware of the discharge process and had managerial positions in the hospital. The sampling process was continued until achieving data saturation. The required information was gathered through reviewing relevant literature, observing the discharge process, and conducting semi-structured interviews with managerial members and study experts. Results: In the present study, the most important factors affecting the discharge process were lack of timely physician visit and issuance of the discharge order, delay in the approval of medication used by pharmacy officer, sending discharge files to hospital discharge unit, the patients' needs, diagnostic services (discharging with doctor's opinion), delays in registering nursing records, and undue secretarial performance in reviewing and recording reports in the hospital information system. Conclusion: The results of the present study, in line with other researches, have shown that the importance of the discharge process on hospital performance is undeniable and this process needs continuous investigation, monitoring, and intervention.

Evaluation of Discharge Coordinators and Their Effect on Discharge Efficiency and Preparedness.

A discharge coordinator role was evaluated to determine if it resulted in more discharges before noon, decreased length of stay, and prepared families for self-care at home. This evaluation took place at a pediatric cardiac care unit. Discharges before noon, reasons for delays, and length of stay were analyzed before and after the discharge coordinator role. Parental knowledge assessments were completed a week after discharge. A nursing survey measured satisfaction with the patient discharge process. Rates of discharge before noon increased (31.68% vs. 44.39%) and length of stay decreased (97.16 vs. 85.24 hr) with a discharge coordinator. Parental knowledge assessment revealed fewer deficits, and nurses were satisfied. A dedicated person to coordinate patient discharge needs can improve discharge efficiency and increase the likelihood of successful self-care at home. Further evaluation is needed to determine how this role impacts readmission.

A Performance Improvement Initiative for Implementing an Evidence-Based Discharge Bundle for Lung Transplant Recipients.

Lung transplant recipients have high hospital readmission rates. Readmissions are costly to institutions and associated with higher mortality among patients within the first year of transplant. Strong evidence indicates that in hospitalized patients, the use of discharge bundles results in lower 30-day hospital readmission rates. A lung transplant team at a Midwest academic medical center performs 40 to 50 lung transplants annually and provides comprehensive, ongoing care for approximately 300 lung transplant recipients. The objective of this quality improvement project was development and implementation of an evidence-based discharge bundle (standardized patient discharge process) to reduce 30-day hospital readmission rates for this patient population. A gap analysis was performed using focus groups to identify strategies to reduce readmissions. Using that data, a standardized discharge bundle was developed in collaboration with the transplant team. The discharge bundle included improvements in discharge planning, scripted communication methods between team members, a standardized medication template for patient education, standardized follow-up appointment process, and increased telephone calls to the patient after discharge. The primary outcome measured was the monthly 30-day hospital readmission rate of facility lung transplant recipients from June through August of 2019 as compared to the same time period in 2018. The readmission rate did not change during the evaluation period. Team members reported improved communication, efficiency, and improved standardization of follow-up care using the discharge bundle. Implementing a discharge bundle for lung transplant recipients resulted in improved staff satisfaction with the discharge process.

A two-week interprofessional teamwork simulation with real cardiac patients

To review a collaborative Lean methodology involving various health professionals for the improvement of interprofessional work and the coordination of care during patient hospitalization to reduce length of stay.Two similar Lean projects were carried out in the geriatric care unit of two hospitals of the Centre Hospitalier Universitaire de Québec (CHU de Quebec). The projects focused on interprofessional collaboration through Lean activities for improving the geriatric patient trajectory and discharge processes. The mean length of stay in the geriatric care unit was measured before and after the project. Secondary outcomes were the length of stay in the emergency room (ER) and the number of medical consultations realized by a geriatric physician in the ER.Projects led to a new shared vision of interprofessional approach in both geriatric care units. The mean length of stay for the first geriatric care unit was reduced by 3 days and by 7 days for the second unit. Optimization in ER flow also been observed for both projects.These interprofessional Lean projects described how a group of various professionals could change their vision from a shared decision making of patient discharge to a collaborative workflow of cares by designing together the process and not focussing on individuals. This collaborative workflow is possible by implementing an interprofessional focus on communication, role clarification and the autonomy of all healthcare professional as soon as the patient is admitted to the ER and during the whole hospitalization period.