Efficiently meeting the most severe challenges of healthcare
How can you reduce length of stay?
What is your HCAHPS score?
Not just the benchmarks, Do you want to attain 100% score in the survey?
What can you do with ED Boarding?
What about patients that "left without being seen"?
Discharge and Admission are undoubtedly the most crucial processes in healthcare. The medical staff is under enormous pressure and constant shortcomings at different levels lead to “timely” Discharge and Admission Failures. If Discharge is delayed, new patients waiting in Emergency Department have to wait longer, and this rise in ED boarding makes them “Leave Without Being Seen”. To tackle discharge delays, Caregivers would often rush up the Discharge process, giving less time to their patients and stepping over the most essential “Time” and “Education” required for patient’s well-being. Such anxious caregivers lead to poor hand-offs between themselves and lead to poor communication with patients and family members. As a result, the not so well informed patients go home without proper consultation and guidance, and raise the readmission rate which is a big liability to the hospital and caregivers. So we see that the Discharge process delays and inefficiency is a big cause of low HCAHPS score So the question is: How to take Caregivers out of this vicious circle of a LOOSE-LOOSE situation by streamlining and standardizing their Discharge process, bump up Admission process and raising overall patient experience, which is the basis of HCAHPS Survey Score
We do a Cause and Effect Analysis in a Fish-Bone diagram to identify the most likely problems!
Waiting Area
- Left without being seen
- Ambulance Diversion
- Fewer Throughputs
- Emergency surgery takes precedence and needs the inpatient room on urgen
- Direct admit from other doctors offices and tertiary hospital block the beds
Admission Problems
- Because Elective surgeries are front loaded during the early part of the week
- Direct admit from other doctors offices and tertiary hospital block the beds
- Because Elective surgeries are front loaded during the early part of the week
- Emergency surgery takes precedence and needs the inpatient room on urgent basis
Discharge Problems
- No sign-off from Physicians, engaged in other emergencies
- Insurance approval for the medications
- Transportation has been not arranged
- Physical Therapy has not been arranged
- Patient not trained to self-administer injections. Patients not being well-informed.
Emerg. Dept. Full
- Emergency Surgery, trauma, chest pain takes precedence
- Long wait times in the ED
- Stress level increases, patient satisfaction decreases.
- Critical patients may be sitting in the waiting area.
- Liability increases
- Insufficient staffing
- Lack of co-ordination between staff
- Improper workload distribution
E.D. Boarding
- Delay in care
- Medical errors
- Medical Negligence
- Ambulance Diversion
- Financial loss to the hospital
- Increased patient mortality
- Increase hospital length of stay
- Unwanted overtime for staff
- Inadequate administrative control
Discharge Process
- Waiting for the ambulance or caretakers
- Nursing home is waiting for insurance approval
- Radiology and other tests are pending
- Pharmacy have not explained about the side effects of the medications
- Social services and care management have not arranged for the resources or home health nursing
- Nursing have not given discharge instructions
Teach-Upfront Methodology or TUM
Communication amongst caregivers is also vital but Time is again a constraint for them as well. Our solution to cope up with this problem is using “Teach-Upfront” Methodology or TUM. We Teach-Upfront with checklists, which have been chunked and articulated for easy memorization.
After Discharge
But Wait!! What happens when the patient goes home, enters his daily routine and forgets about the
Discharge Instructions, the Teach-Backs given during stay and Discharge?
What can you as an eager caregiver do to counter this situation. You can't be there with him in his daily routine, how can you still touch base with him for certain vital checklists that you taught and educated the patient for?
We also have YouTube videos so patients can learn about this checklist’s at their own pace. Basically, we are bringing “in-line” all the resources to make patients TUM, help them with short-term memory and long-term memory. TUM will help them to change their habit-loop. TUM doesn’t replace Teach-Back. TUM and Teach-Back together will help to retain the discharge instructions.
Out of Sight is
Out of Mind
We need to upgrade to a 24x7 tangible “TouchPoint” that will help the patients which can buzz the patient every now and then and expose
the Checklists and Mnemonics so that he is always prepared to ask questions upfront. We devised the Communication Box.
Routine is giving discharge instructions at the time of discharge and that at time a lot of medical information is given to the patient, which is difficult for them to remember even if caregivers do a Teach-Back. In the first 24 hours, there is a steep drop off in retention of the information passed to the patients. We at Vital Checklist propose adding Teach-Upfront with standardized printed checklists on the Communication Box. This will be an adjunct to the Teach-Back method, which is used to discuss the customized discharge instructions printed through electronic health records. As per Charles Duhigg, if you want to change habits, keep the old cue and the old reward and introduce the new routine.
