1. Inves&ga&ng
the
Usage
of
an
Es&mated
Date
of
Discharge
for
Occupancy
Workflow
Improvement
Flores,
K1.,
Lo,
A1.,
Sla0ery,
D1.,
DasGupta,
T.2,
Gagliardi,
L.2
1.
University
of
Toronto
IHI,
2.
Sunnybrook
Health
Sciences
Centre
Sunnybrook’s
overarching
goal
is
to
reduce
occupancy
of
acute
care
beds,
however
the
discharge
strategy
focuses
on:
-­‐ Early
communicaMon
(from
admission)
of
the
discharge
plan
to
paMent
and
family
-­‐ IdenMfying
potenMal
factors
that
can
lead
to
a
problemaMc
discharge
as
early
as
possible,
throughout
the
paMent
care
period
Introduction
Objectives
Methods
Results Results
Conclusion
Acknowledgements
Sunnybrook
Health
Sciences
Centre
is
frequently
experiencing
occupancy
rates
that
exceed
100%.
A
focus
area
leading
to
high
occupancy
rates
is
the
discharge
process
which,
upon
admission,
handles
how
and
when
paMents
leave
the
hospital.
There
exists
a
need
to
ensure
that
all
paMent
and
family
concerns
are
met
up
unMl
discharge,
while
at
the
same
Mme
ensuring
that
a
Mmely
paMent
flow
and
high
quality,
person-­‐centered
experience
is
maintained.
It
was
determined
that
communicaMon
of
an
EsMmated
Date
of
Discharge
(EDD)
would
be
beneficial
to
both
the
paMent
family
and
healthcare
staff
to
improve
discharge
workflow.
The
following
intervenMons
were
measured
to
determine
EDD
effecMveness:
1. UpdaMng
paMent
bedside
whiteboards
with
the
EDD
to
encourage
proacMve
idenMficaMon
of
concern
2. Care
round
script
(a
4
quesMon
tool
to
help
support
discharge
and
person
centered
care
discussions)
3. Feedback
from
paMents
via
inpaMent
interviews
and
post-­‐discharge
phone
call
surveys
10
20
286
1
18
EDD
Barriers
within
Sunnybrook
control
-­‐
Between
Jan
12th
&
Mar
31st
Total
337
whiteboards
OR
Receiving
Treatment
Care
Decision
Pending
WaiMng
for
Consult
Insufficient
Materials
Figure
1:
Barriers
to
why
EDD
could
not
be
discussed
to
paMents
via
whiteboard
Figure
2:
Results
of
the
care
round
script
to
foster
discussion
of
paMent
discharge
Early
feedback
from
discharged
paMents
show
that
only
25%
reached
the
DB11
goal
(Fig.
3),
however
more
data
is
required
to
determine
if
improvement
is
being
made.
Major
barriers
to
discussing
EDD’s
were
discovered
(Fig.
1)
and
should
further
undergo
deep
dive
analysis.
One
notable
menMon
is
that
paMents
oben
disliked
the
idea
of
discussing
an
EDD
during
admission
or
the
early
stages
of
care.
Most
paMent
comments
pertained
to
their
own
well
being,
such
as
what
they
need
to
do
in
order
to
stay
healthy
outside
of
hospital
and
only
20%
valued
being
told
an
EDD
(Fig.
3)
within
the
first
day
of
their
admission.
Next
steps
could
include
the
creaMon
of
a
process
map
that
captures
all
current
discharge
processes.
This
type
of
analysis
would
facilitate
accurate
idenMficaMon
the
processes
in
greatest
need
of
improvement,
and
would
help
demonstrate
how
the
those
processes
affect
the
others.
We
would
like
to
thank
Tracey
Das
Gupta,
Lina
Gagliardi,
Florina
Weisenberg,
and
Therese
Loo
for
the
opportunity
to
parMcipate
on
the
Discharge
Working
Group,
and
for
their
conMnuous
effort
in
helping
us
along
the
way.
63%
81%
79%
72%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Script
Followed
Person’s
goals/concerns
discussed
EDD
Discussed
Team
Member
iden&fied
for
follow-­‐
up
%
From
Total
Ques&ons
Care
Round
Compliance
5
Weeks
(Between
Jan
20th
and
Mar
27th)
Total
of
1,031
pa&ents
Units:
B4,
C2,
C4,
C5,
C6,
D2,
D3,
D4,
D5,
D6ENT
and
D6URO
Figure
3:
Feedback
from
paMents,
post-­‐discharge
Table
1:
Most
common
comments/concerns
from
inpa&ent
experience
surveys
Home
care
(ex.
How
do
I
cope
living
at
home?)
Family
GP
Involvement
TransportaMon
(ex.
who
will
pick
me
up
to
return
home
or
move
to
LTC?)
Equipment
(ex.
How
do
I
obtain
a
walker?)
CCAC
CoordinaMon
–
start
the
process
when
paMent
is
admi0ed
24%
20%
45%
25%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Told
EDD
during
admission
EDD
within
24
hours
valuable?
Delays
during
discharge?
Discharged
before
11?
%
From
Total
Ques&ons
Post
discharge
pa&ent
surveys
Total
of
21
pa&ents
May
2,
2015