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International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume 4 Issue 4, June 2020 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470
@ IJTSRD | Unique Paper ID – IJTSRD30919 | Volume – 4 | Issue – 4 | May-June 2020 Page 222
A Study on Delay in Discharge Process, in
One of Multispeciality Hospital in Tanjore
K. Revathi1, Mrs. U. Suji2
1Student, 2Assistant Professor,
1,2Department of Hospital Administration, Dr. N.G.P. Arts and Science College, Coimbatore, Tamil Nadu, India
ABSTRACT
Discharge delays are one of those problems that spoil the overall pleasant
experience inside the hospital. The study was conducted to identify the
reasons and determinants of discharge delay in acute patients care. Delayed
discharge is usually associated with a patient’s medical conditions, delayed
health care or medical advice, delayeddiagnosticservices, anddelayedrelated
health services. This paper deals with the discharge delay of inpatients in a
selected hospital. An annexure was prepared to see the time takenbypatients
from the time of discharge till they actually leave the hospital premises. The
outcome that is expected from this study was to identify the reasons for the
delay of discharge and to come up with suggestions to reduce them.
KEYWORDS: Discharge delay, Accrued care patients, Medical consultation, Non
English speaking
How to cite this paper: K. Revathi | Mrs.
U. Suji "A Study on Delay in Discharge
Process, in One of MultispecialityHospital
in Tanjore"
Published in
International Journal
of Trend in Scientific
Research and
Development
(ijtsrd), ISSN: 2456-
6470, Volume-4 |
Issue-4, June 2020, pp.222-224, URL:
www.ijtsrd.com/papers/ijtsrd30919.pdf
Copyright © 2020 by author(s) and
International Journal ofTrendinScientific
Research and Development Journal. This
is an Open Access article distributed
under the terms of
the Creative
CommonsAttribution
License (CC BY 4.0)
(http://creativecommons.org/licenses/by
/4.0)
1. INTRODUCTION
1.1. Definition:
Admission is the entry of a patient hospital/ward for
therapeutic/diagnostic purpose. To provide health care
services by observation, investigation, treatment and care.
The discharge of a patient from the hospital means the
release of a person admitted tothehospital fromthehospital
setting. Discharge delay is common for multi-specialty
hospitals, discharge delay refer to situation of the patients
were they are unable to leave the hospital, because it takes
more time to complete the process.
1.2. Discharge process:
A. Consultant notification of patient discharge
B. Discharge Summary Prepared
C. Drugs Returned to Pharmacy
D. Drugs Returned Acknowledged by Pharmacy
E. Discharge Initiated
F. Activity Card send to billing
G. Patient Settlement of bill
H. Patient discharged
The objectives of the study include:
A. To study the discharge process.
B. To identify the causes of delay in discharge process.
C. To suggest measures to reduce the delay in discharge
process.
2. Literature review
According to Lixia Ou, Lis Young, a study was conducted
to identify the reasons and determinants of discharge
delay in acute patients, the increasing demand for acute
care hospital beds and a push for cost cutting requires
efficient discharge planning. Delayed discharge has
become a major issue because it leads to unanticipated
length of stay and bed block. Both the quality and cost-
effectiveness of care may be compromised as a result.In
Australian context, delayed discharge is a major reason
for the unavailability of beds in major acute care
hospitals.
According to the study of Andrew P Costa, Jeffry WPoss,
it was identified the acute hospital discharge delays
were the pressing concern for many health care
administrator. In Canada, a delayed is defined by the
alternate level of care [ALC] construct and has been the
target of many provincial health care strategies. Little is
known on the patient characteristics that influence
acute ALC length of stay. This stay examines which
characteristic drive acute ALC length of stay those
awaiting nursing home admission.
According to Michael Emes, Smith, Suzanne, in the
period from January 2013 to July 2014, three process
change initiatives were undertaken at a major UK
hospital to improve the patientdischarge process.These
initiatives were inspired by the findings of a study of
discharge process using soft systems methodology. The
IJTSRD30919
International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Paper ID – IJTSRD30919 | Volume – 4 | Issue – 4 | May-June 2020 Page 223
first initiative simplified time-consuming paperwork
and the second introduced more regular reviews of
patient progress through daily multi- disciplinary’’
situation reports.
3. Methodology
The method used to collect the data was simple random
sampling technique. According to Morgan’s table 169 data
were taken and analyzed. The methodofdata collectionused
was checklist, which verified patient ID, Date, Ward, Doctor
Entry time, Doctor Advice time, Doctor report writing time,
Discharge summary time, Patient out time & Remarks, on
four wards. This checklist helps to identify the rootcausesof
the problem and reduce the delays in the Multi-specialty
hospitals. Tool used for analysis is simple percentage
analysis.
4. Analysis
Chart 1.1 showing the percentage analysis of discharge delays in the discharge process
This chart shows that billing time (47%) is the highest delay when compared to other discharge process.
Chart 1.2 showing the percentage analysis of discharge delays in different wards
This chart shows that general ward-female (36%) has reported the highest delay when compared to other wards.
Chart 1.3 showing the percentage analysis of discharge delay
International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Paper ID – IJTSRD30919 | Volume – 4 | Issue – 4 | May-June 2020 Page 224
From the above chart, it is understood that discharge delay between 0-1 hours is 47.93%, which is highest.
From the above chart, it is understood that discharge delay between 1-2 hours is 21.31%
From the above chart, it is understood that discharge delay between 2-3 hours is 9.47%
From the above chart, it is understood that discharge delay between 3-4 hours is 6.51%
From the above chart, it is understood that discharge delay above 4 hours is 14.8%
5. Major findings & recommendations
New nurses are not formally trained in the discharge
process.
There is only one billing counter for IP and OP.
It is too late for insurance patients to get approval from
their respective companies.
Main cause of delay in discharge of inpatients is in
providing medicines in the ward or collectingmedicines
in the pharmacy before getting discharged.
More Time is consumed in preparation of Discharge
summary.
The recommendations include,
Proper training for the discharge process should be
provided to nurses.
Inpatients should be notified at least one day before
discharge.
Increase the number of staff at the pharmacy in order to
reduce the waiting time for the drug to be collected.
Discharge summary should be sent online to Insurance
Dept
Also setting up one more billing counter, will reducethe
time delay
6. Conclusion
Therefore, the use of acute hospital beds is of particular
importance at this time. Concentrating more on reducing
discharge delay and considering the providedsuggestions in
this study may help to improve the hospitals reputation and
which may also help in accommodating more patients for
better treatment and health supports.
7. References
[1] Sima Ajami, Saeedeh ketabi,’’An analysis of average
waiting time during the patient discharge process at
KASHNI Hospitsl in Esfahan, Iran’’: a case study, health
information management journal 36(2),37-42, 2007
[2] Kenji Morimoto, Masanori Kunieda , ‘’ sinking EDM
simulation by determing discharge location s based on
discharge delay time’’. CIRP Annals volume58, issue,
2009, pages221-224.
[3] Jeanette Semke MSW, Tad VanDerWeele MSW &
Richard Weatherley, “Delayed Discharges for Medical
and surgical patients in an acute care hospital”,Journal
of social work in Health care, Volume 14, Issue 1, Page
15- 31, 1989
[4] Ankit Singh “Insuredpatient’sdischargedelays:causes
and solutions, Journal of the Academy of Hospital
Administration, Volume 30, No.2 July-December,2018
[5] Filipa Landeiro, MA, MSc, “Delayed hospital discharges
of older patients: Asystematic Review on Prevalance
and Costs”, The Gerontologist, Volume 59, Issue 2,
Pages e86- e97, April 2019
[6] Kasthuri Shukla ”PredictiveModellingforTurnAround
Time(TAT) of discharge process for insuredpatientsin
a Corporate Hospital of Pune city”, Journal of Health
Management 20(1) 56- 63, 2018
[7] Aleli D. Kraft PhD, Stella A. Quimbo PhD, The Journal of
Pediatrics, Volume 155, Issue 2, August 2009, Pages
281-285
[8] Sima Ajmi, Saeedeh Ketabi, “An AnalysisoftheAverage
Waiting Time during the Patient Discharge Process at
Kashani Hospital in Esfahan, Iran: A Case Study”,
Journal of health information management, 2007,
volume 36, Issue 2, Page 37- 42
[9] Brian Cowie, Petrea Corcoran, ’’Postanethesia careunit
discharge delay for nonclinical reasons’’,journal ofperi
Anethesia nursing volume 27, issue 6 december2012,
pages393-398.
[10] SC Lim, V doshi, B castasus, JKH lim, Kmamun’’Factors
Causing delay in discharge of Eldery patients in an
acute care hospitals’’, annals- academy of medicine
singapore35, (1), 27, 2006.

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A Study on Delay in Discharge Process, in One of Multispeciality Hospital in Tanjore

  • 1. International Journal of Trend in Scientific Research and Development (IJTSRD) Volume 4 Issue 4, June 2020 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 @ IJTSRD | Unique Paper ID – IJTSRD30919 | Volume – 4 | Issue – 4 | May-June 2020 Page 222 A Study on Delay in Discharge Process, in One of Multispeciality Hospital in Tanjore K. Revathi1, Mrs. U. Suji2 1Student, 2Assistant Professor, 1,2Department of Hospital Administration, Dr. N.G.P. Arts and Science College, Coimbatore, Tamil Nadu, India ABSTRACT Discharge delays are one of those problems that spoil the overall pleasant experience inside the hospital. The study was conducted to identify the reasons and determinants of discharge delay in acute patients care. Delayed discharge is usually associated with a patient’s medical conditions, delayed health care or medical advice, delayeddiagnosticservices, anddelayedrelated health services. This paper deals with the discharge delay of inpatients in a selected hospital. An annexure was prepared to see the time takenbypatients from the time of discharge till they actually leave the hospital premises. The outcome that is expected from this study was to identify the reasons for the delay of discharge and to come up with suggestions to reduce them. KEYWORDS: Discharge delay, Accrued care patients, Medical consultation, Non English speaking How to cite this paper: K. Revathi | Mrs. U. Suji "A Study on Delay in Discharge Process, in One of MultispecialityHospital in Tanjore" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456- 6470, Volume-4 | Issue-4, June 2020, pp.222-224, URL: www.ijtsrd.com/papers/ijtsrd30919.pdf Copyright © 2020 by author(s) and International Journal ofTrendinScientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (CC BY 4.0) (http://creativecommons.org/licenses/by /4.0) 1. INTRODUCTION 1.1. Definition: Admission is the entry of a patient hospital/ward for therapeutic/diagnostic purpose. To provide health care services by observation, investigation, treatment and care. The discharge of a patient from the hospital means the release of a person admitted tothehospital fromthehospital setting. Discharge delay is common for multi-specialty hospitals, discharge delay refer to situation of the patients were they are unable to leave the hospital, because it takes more time to complete the process. 1.2. Discharge process: A. Consultant notification of patient discharge B. Discharge Summary Prepared C. Drugs Returned to Pharmacy D. Drugs Returned Acknowledged by Pharmacy E. Discharge Initiated F. Activity Card send to billing G. Patient Settlement of bill H. Patient discharged The objectives of the study include: A. To study the discharge process. B. To identify the causes of delay in discharge process. C. To suggest measures to reduce the delay in discharge process. 2. Literature review According to Lixia Ou, Lis Young, a study was conducted to identify the reasons and determinants of discharge delay in acute patients, the increasing demand for acute care hospital beds and a push for cost cutting requires efficient discharge planning. Delayed discharge has become a major issue because it leads to unanticipated length of stay and bed block. Both the quality and cost- effectiveness of care may be compromised as a result.In Australian context, delayed discharge is a major reason for the unavailability of beds in major acute care hospitals. According to the study of Andrew P Costa, Jeffry WPoss, it was identified the acute hospital discharge delays were the pressing concern for many health care administrator. In Canada, a delayed is defined by the alternate level of care [ALC] construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This stay examines which characteristic drive acute ALC length of stay those awaiting nursing home admission. According to Michael Emes, Smith, Suzanne, in the period from January 2013 to July 2014, three process change initiatives were undertaken at a major UK hospital to improve the patientdischarge process.These initiatives were inspired by the findings of a study of discharge process using soft systems methodology. The IJTSRD30919
  • 2. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD30919 | Volume – 4 | Issue – 4 | May-June 2020 Page 223 first initiative simplified time-consuming paperwork and the second introduced more regular reviews of patient progress through daily multi- disciplinary’’ situation reports. 3. Methodology The method used to collect the data was simple random sampling technique. According to Morgan’s table 169 data were taken and analyzed. The methodofdata collectionused was checklist, which verified patient ID, Date, Ward, Doctor Entry time, Doctor Advice time, Doctor report writing time, Discharge summary time, Patient out time & Remarks, on four wards. This checklist helps to identify the rootcausesof the problem and reduce the delays in the Multi-specialty hospitals. Tool used for analysis is simple percentage analysis. 4. Analysis Chart 1.1 showing the percentage analysis of discharge delays in the discharge process This chart shows that billing time (47%) is the highest delay when compared to other discharge process. Chart 1.2 showing the percentage analysis of discharge delays in different wards This chart shows that general ward-female (36%) has reported the highest delay when compared to other wards. Chart 1.3 showing the percentage analysis of discharge delay
  • 3. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD30919 | Volume – 4 | Issue – 4 | May-June 2020 Page 224 From the above chart, it is understood that discharge delay between 0-1 hours is 47.93%, which is highest. From the above chart, it is understood that discharge delay between 1-2 hours is 21.31% From the above chart, it is understood that discharge delay between 2-3 hours is 9.47% From the above chart, it is understood that discharge delay between 3-4 hours is 6.51% From the above chart, it is understood that discharge delay above 4 hours is 14.8% 5. Major findings & recommendations New nurses are not formally trained in the discharge process. There is only one billing counter for IP and OP. It is too late for insurance patients to get approval from their respective companies. Main cause of delay in discharge of inpatients is in providing medicines in the ward or collectingmedicines in the pharmacy before getting discharged. More Time is consumed in preparation of Discharge summary. The recommendations include, Proper training for the discharge process should be provided to nurses. Inpatients should be notified at least one day before discharge. Increase the number of staff at the pharmacy in order to reduce the waiting time for the drug to be collected. Discharge summary should be sent online to Insurance Dept Also setting up one more billing counter, will reducethe time delay 6. Conclusion Therefore, the use of acute hospital beds is of particular importance at this time. Concentrating more on reducing discharge delay and considering the providedsuggestions in this study may help to improve the hospitals reputation and which may also help in accommodating more patients for better treatment and health supports. 7. References [1] Sima Ajami, Saeedeh ketabi,’’An analysis of average waiting time during the patient discharge process at KASHNI Hospitsl in Esfahan, Iran’’: a case study, health information management journal 36(2),37-42, 2007 [2] Kenji Morimoto, Masanori Kunieda , ‘’ sinking EDM simulation by determing discharge location s based on discharge delay time’’. CIRP Annals volume58, issue, 2009, pages221-224. [3] Jeanette Semke MSW, Tad VanDerWeele MSW & Richard Weatherley, “Delayed Discharges for Medical and surgical patients in an acute care hospital”,Journal of social work in Health care, Volume 14, Issue 1, Page 15- 31, 1989 [4] Ankit Singh “Insuredpatient’sdischargedelays:causes and solutions, Journal of the Academy of Hospital Administration, Volume 30, No.2 July-December,2018 [5] Filipa Landeiro, MA, MSc, “Delayed hospital discharges of older patients: Asystematic Review on Prevalance and Costs”, The Gerontologist, Volume 59, Issue 2, Pages e86- e97, April 2019 [6] Kasthuri Shukla ”PredictiveModellingforTurnAround Time(TAT) of discharge process for insuredpatientsin a Corporate Hospital of Pune city”, Journal of Health Management 20(1) 56- 63, 2018 [7] Aleli D. Kraft PhD, Stella A. Quimbo PhD, The Journal of Pediatrics, Volume 155, Issue 2, August 2009, Pages 281-285 [8] Sima Ajmi, Saeedeh Ketabi, “An AnalysisoftheAverage Waiting Time during the Patient Discharge Process at Kashani Hospital in Esfahan, Iran: A Case Study”, Journal of health information management, 2007, volume 36, Issue 2, Page 37- 42 [9] Brian Cowie, Petrea Corcoran, ’’Postanethesia careunit discharge delay for nonclinical reasons’’,journal ofperi Anethesia nursing volume 27, issue 6 december2012, pages393-398. [10] SC Lim, V doshi, B castasus, JKH lim, Kmamun’’Factors Causing delay in discharge of Eldery patients in an acute care hospitals’’, annals- academy of medicine singapore35, (1), 27, 2006.