This article is the second in a series on the hospital of the future, designed to get our readers thinking and planning ahead for their own facilities.
Hospitals across the country wrestle with improving their discharge process, whether the goal is gaining a more time- and cost-effective outcome for the facility, or improving quality measures for patients upon departure, or both.
“A lot of people are attacking discharge problems from a lot of different angles,” says Vineet Arora, MD, academic hospitalist and researcher, University of Chicago Pritzker School of Medicine.
What will hospital discharge look like in the future? Based on current research, trials, and trends, it seems there are few surprises down the road in this area. The changes will come in the form of fine-tuning critical areas in the process rather than implementing new technology to radically change the way we release patients. Positive changes seem to be people-based rather than computer-based.
“Everybody’s on the technology bandwagon, but we have to understand the processes first,” says Lakshmi Halasyamani, MD, associate chair for the Department of Internal Medicine, St. Joseph Mercy Hospital, Ann Arbor, Mich. “Better technology won’t make care safer or more efficient. We have to examine how we organize care delivery, then look at technology. Otherwise it replicates the inefficiencies we have now.”
Here are some predictions for how the discharge process will be improved in the hospital of the future.
THE DISCHARGE PROCESS WILL BE SMOOTHER AND SAFER
Most hospital-based professionals agree that discharge is an area of care that needs more attention.
“Every day that you’re [in the hospital], we spend a little less time with you,” says Dr. Halasyamani. “We undervalue the risk of discharging patients; we need to focus on [the patients] more. The nurse calls us, and we get the discharge done as quickly as possible.”
In the hospital of the future, the discharge process will be driven by specific structured guidelines that ensure patients safety when they leave the hospital. Every discharge will involve a multidisciplinary team, with members signing off that the patient is not only ready to leave the hospital, but informed about their condition and any next steps, and has necessary medications or prescriptions in hand.
As for improving efficiency, minor changes can make a big difference. Chad Whelan, MD, assistant professor of medicine, University of Chicago Hospitals, is part of a task force working on how to move hospital discharges earlier in the day.
“An earlier discharge is better for everyone, including the patient—especially if they’re being transferred to another facility,” he points out. “One thing we’re looking at is the way diagnostic tests are categorized. Everything falls into two categories now: emergency diagnostics and everything else.”
Dr. Whelan and the taskforce have asked departments, including radiology and other labs, to create a third category: for patients waiting for a test before they can be discharged. All it takes is one question on the part of the service provider: “Is this patient waiting for these results before she can go home?” to move that patient to the front of the line.
Another recommendation Dr. Whelan’s task force will make involves staffing up. “Like we ramp nursing staff up and down depending on the census, we are looking at doing that with case managers and ward clerks to handle heavy discharge times,” he says.
David J. Rosenman, MD, senior associate consultant, Hospital Internal Medicine, Mayo Clinic in Rochester, Minn., suggests that paperwork might also be changed. “The discharge summary of the future will be more visual,” he predicts. “There are ways of displaying information that are more sophisticated and probably more helpful than static lists and linear prose alone.”