PROPEL Discharge: An Interdisciplinary Throughput Initiative

Background

Increased care demands at a health care institution led to strained resources, emergency department (ED) congestion, safety events, and patient and employee dissatisfaction. Moreover, high volumes of afternoon discharges contributed to limited early morning bed availability and admission bottlenecks.

Methods

A 29-month pre-post design quality improvement project on 19 acute care, adult medicine units across two campuses at a large academic medical center was implemented to improve discharge timeliness, length of stay (LOS), and ED throughput by increasing pre-11:00 a.m. discharges. Based on Lean Six Sigma methodology, interventions included standardized interdisciplinary discharge processes and roles, processes to ensure performance data transparency and access, a recognition program, and a barrier tracking and mitigation process for continued improvements.

Results

During the intervention period, pre-11:00 a.m. discharges increased from 5.1% to 21.8% (p < 0.001), discharge orders were entered 42 minutes earlier (p < 0.001), patients were discharged 56 minutes earlier (p < 0.001), the percentage of discharges completed within 90 minutes from discharge order improved from 26.2% to 38.1% (p < 0.001), the percentage of discharges by 3:00 p.m. improved from 44.7% to 55.9% (p < 0.001), ED admissions arrived to units 44 minutes earlier (p < 0.001), median LOS decreased by 0.46 days (p < 0.001), median observed-to-expected (O:E) LOS decreased by 0.05 (p < 0.001), and opportunity day reductions contributed to increased bed capacity of 18.84 beds per day.

Conclusion

Early morning discharges are associated with improved patient throughput and are safe, achievable, and sustainable via interventions focused on frontline engagement, interdisciplinary collaboration, standardization, barrier mitigation, data accessibility, and accountability.