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Process for improving early hospital discharge: a study of outcomes

García Alonso D, Enguix N, Valverde L, Castells M, Pascual I, Esquerda A, Sarlé J

Directora del Ámbito de Atención Urgente. Coordinadora Administrativa de Hospitalización. Coordinadora Administrativa de Urgencias. Coordinadora de Enfermería del Área Médica. Coordinadora de Enfermería del Área Qui

Objectives: To describe process changes implemented to encourage early hospital
discharge and reduce emergency admission delays for adult medical and surgical
patients and to analyze outcomes achieved.
Methods: Our hospital’s discharge system was analyzed to identify the main
shortcomings. The process was then reengineered to create a hospital discharge plan
whose implementation required several changes in care pathways and information
systems. We gathered data on discharges of adult medical and surgical patients during 3
shifts (9 A.M. to 1 P.M.; 1 to 5 P.M.; 5 to 9 P.M.) before (2006) and during the 2 years
(2008-2009) following the plan’s introduction in 2007. Outcomes were compared using
the Ă·2 test.
Results: The early hospital discharge plan improved the care pathways involved in this
complex process at all levels of our organization, leading to an increase of 30% in the
overall number of discharges within 13 hours of admission (P<.001), mainly attributable
to early medical discharges.
Conclusions: Multidisciplinary teamwork and the cooperation of key persons in the
system made it possible to discharge more patients within half a day. Use of clinical
information storage and retrieval systems were essential for coordinating efforts and
automating tasks in real time. The plan also represented an important cultural shift in
our planning of hospital discharges.

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