A Lean Six Sigma Quality Improvement Project Improves Timeliness of Discharge from the Hospital

Joint Commission Journal on Quality and Patient Safety
Mithu MollaVoltaire Sinigayan

Abstract

Hospital overcrowding has become a widespread problem, with constrained bed capacity and admission bottlenecks having far-reaching negative impacts on quality and safety. Focus on timing of discharge may be the least disruptive and most effective way to address constrained bed capacity, yet there may be significant institution-specific barriers to implementation. With the creation of a "Value Team," a 627-bed, tertiary care academic medical center embarked on a quality improvement (QI) project using Lean Six Sigma process improvement methodology. After defining the problems around timeliness of discharge, the team went through the steps in the Define, Measure, Analyze, Improve, Control (DMAIC) framework. Interventions, which were implemented on the basis of an in-depth analysis of barriers to the discharge process, included geographic cohorts of internal medicine physicians on specific hospital units and multidisciplinary huddles one day before anticipated discharge. After accounting for the concurrent trends in the control group, the percentage of discharge orders released by 10:00 a.m. increased by 21.3 points (p < 0.001; adjusted odds ratio [OR] = 2.62; 95% confidence interval [CI] = 1.91-3.59), and the percentage of patient...Continue Reading

Citations

Aug 2, 2019·The International Journal of Health Planning and Management·Jamison V Kovach, Madhumita Akhuli
Dec 31, 2019·International Journal of Health Care Quality Assurance·Deoraj Prajapati, Gaurav Suman
Feb 23, 2020·Journal of Nursing Care Quality·Rebecca WoodsLaura Sarff
Sep 4, 2020·Inquiry : a Journal of Medical Care Organization, Provision and Financing·Ling-Feng ZhuHai-Xiao Chen
Aug 8, 2020·International Journal of Environmental Research and Public Health·Carlos Zepeda-LugoGuilherme Tortorella
Jul 25, 2021·International Journal of Environmental Research and Public Health·Letícia Bianchini de BarrosRenata Cristina Gasparino

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