The document analyzes the discharge process at Apollo Hospital in Ahmedabad, finding that the average time for discharge is over 500 minutes which exceeds their 120 minute standard. It identifies delays occurring in the pre-billing, billing, and post-billing phases, and recommends improvements like planning discharges, coordinating staff, and updating bills daily to reduce turnaround times.

1. CASE STUDY ON DISCHARGE PROCESS
AND TURNAROUND TIME IN APOLLO
HOSPITAL, AHMEDABAD
9/18/2022
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2. APOLLO HOSPITAL AHMEDABAD
 Apollo Hospitals group is recognized as
the "Architect of Healthcare" in India
 Apollo Hospitals, Ahmedabad opened in May 2003.
 Mission:
 “Our mission is to bring healthcare of international
standards within the reach of every individual. We
are committed to the achievement and
maintenance of excellence in education, research
and healthcare for the benefit of humanity.”
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3. DISCHARGE PROCESS IN A HOSPITAL
 Discharging a patient is an activity common to
every hospital
 The discharge process can have an impact on
numerous factors, such as patient satisfaction
 Numerous activities must be completed
 This work toward discharge day should begin upon
admission
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4. OBJECTIVE OF STUDY
Aim of study:
 To study discharge process in Apollo Hospital and measure
turnaround time and reasons for delay in discharge.
Problem Statement:
 Apollo Hospital Ahmedabad has set standard of 120 min for
discharge process but they are failed to achieve it. Because of this
reason case study on discharge process is taken to find out probable
causes for the delay in discharge of the patient.
Objectives of Study:
 To study the discharge process in the hospital
 To understand the processes from the point of view of the
stakeholders
 To understand the strengths and deficiencies in the existing system
 To suggest suitable measures for improvement
 To study the total turnaround time for discharge of patient from
Hospital
 Suggesting suitable recommendations for improvement of quality of
patient care
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5. METHODOLOGY
 Observation of the discharge processes in the hospital.
 Carrying out a time motion study of the patient flow through the
system and documenting the time consumed for various sub
processes
 Understanding the qualitative aspects of the processes through
unstructured interviews of the patients & employees(Staff -nurses,
Ward Clerk, Ward Officer, Employees of Billing, Medical Officer,
Consultant)
Sources of Data Collection:
Primary Sources:
 Study of patient flow through discharge process
 Unstructured interviews of staff
 Observation
Secondary Sources:
 SOP of the Department
 Number of cases observed (sample size) - 60 [30 form deluxe ward,
10 from standard ward and 20 form private and semiprivate wards]. It
includes TPA patients, corporate patients and cash paid patients.
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6. SOP OF DISCHARGE PROCESS
Policy on Patient Discharge:
 The patient is discharged once the treatment is
complete.
 An authorized written order from the Consultant/ Medical
Officer is given, consultant shall document discharge
instructions
 The discharge summary is prepared by the on duty
Medical officer, Consultant verifies and signs the
discharge summary
 Discharge checklist to be completed by the nurse
 If the patient is having poor surgical condition and the
relatives want to take him/her from the hospital they are
informed about the risk involved
 In case of MLC ensure that the police are informed
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7. Consultant orders discharge
of patient
Nurse informs MO
about discharge of
patient
MO prepares discharge
summary of patient
Discharge summary is
given to typist for typing
consultant verifies discharge
summary
Discharge summary is
retyped after corrections
Final Summary is signed by
consultant
MO explains medicines to
relatives and followup
guidelines
Nurse informs Ward
secretary about discharge
of patient
Ward secretary prepares
inpatient file
fills billing card and
enters all things in
module
Sends billing card to
Inpatient billing Dept for
final billing
Billing department calls
after final bill is ready
After settlement of bill
relatives bring discharge
slip
Ward secretary hand overs
patients reports and
discharge summary
Patient leaves
hospital
For TPA patient Final bill is
send to TPA desk
From TPA desk Final bill and
Discharge summary is mailed
to TPA Co.
TPA Co. sends final approval
for bill
After final approval from TPA
co.discharge slip is generated
from billing dept
Nurse informs
pharmacist about
discharge of patient
Pharmacist checks patient
medicines
Pharmacist returns extra
medicines and indent
discharge medicines for
patinet
Delivers dischage
medicines to ward
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8. FINDINGS AND ANALYSIS
0
100
200
300
400
500
600
1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
Time Taken for Discharge(min)
Time Taken for Discharge(min)
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9. 0
50
100
150
200
250
300
350
400
450
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59
Delays in pre billing phase(min)
Delays in billing phase(min)
Delays in post billing Phase(min)
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10. 10
Discharge
Delays
Material Methods Machine
Environment Manpower Measurement
Causes of Delays
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11. ISSUES IN THE HOSPITAL
 As the entire process is a multi-step procedure
 No specific time of consultants taking rounds
 Billing process
 Discharge summary has to be seen by consultant
 Typist and ward secretary duties impacts discharge
process in big way
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12. RECOMMENDATIONS
 Discharges should be planned
 Consultant should write discharge medicines
 Proper coordination of all staff
 Bills should be updated on a daily basis, especially
Surgeries and other procedures. Discounts should also
be updated daily.
 Doctors should convey expected date of discharge.
Change in date should be intimated.
 Nurses should be trained to discharge patients the next
morning if the doctor has said so the previous evening.
Thus they can do the same on Sundays & Bank
Holidays
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13. 9/18/2022
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