Objective:

Our new discharge pathway defined requirements for each stakeholder, including “medically ready for discharge” lists encompassing: syncope, TIA, seizure, and demyelination.  This provides that discharge will be completed within 2 hours from release of discharge orders. We hoped to achieve this in 60% of cases.

Background:

Inefficient discharges impair patient flow and critically limit bed capacity. The prior system lacked standardized discharge pathways, creating unpredictable discharge delays. We demonstrated that creating a discharge pathway, coupled with specific diagnoses for a medically ready for discharge listing, averts discharge delays. This process enabled the UCLA health system reliably to predict expected discharges.

Design/Methods:

A multidisciplinary team collaborated to create successful discharge pathways. Check lists were created. We met as a multidisciplinary team to define appropriate discharge criteria for specified diagnoses. Once the patient fulfills discharge criteria, the provider releases the discharge orders and alerts the nurse, case manager, and pharmacist via a secure chat notification in EPIC that discharge orders are released. Nurses then discharge the patient within two hours. SPCC, X-chart, S-charts, and P-charts, manually captured metric outcomes on flow failures, a process that ultimately will be automated.

Results:

Between 11-28-23 and 5-31-23, 80% of patients were discharged within two hours. The average time from discharge order release to discharge decreased from 208 minutes to 93 minutes. LOS declined from 5.4 days to 2.4 days. CMI increased from 1.78 to 2.09. Excess bed days improved. Patients and providers were satisfied that the process was helpful and did not additionally burden workflow.

Conclusions:

This pathway, coupled with specific diagnoses for a medically ready for discharge listing, averts discharge delays.We will expand to other neurology diagnoses, and teach other service lines how to streamline their discharge process.