Process for improving early hospital discharge: a study of outcomes

Objectives: To describe process changes implemented to encourage early hospital discharge and reduce emergency admission delays for adult medical and surgical patients and to analyze outcomes achieved. Methods: Our hospital's discharge system was analyzed to identify the main shortcomings. The process was then reengineered to create a hospital discharge plan whose implementation required several changes in care pathways and information systems. We gathered data on discharges of adult medical and surgical patients during 3 shifts (9 a.m. to 1 P.M.; 1 to 5 P.M.; 5 to 9 P.M) before (2006) and during the 2 years (2008-2009) following the plan's introduction in 2007. Outcomes were compared using the chi(2) test. Results: The early hospital discharge plan improved the care pathways involved in this complex process at all levels of our organization, leading to an increase of 30% in the overall number of discharges within 13 hours of admission (P <.001), mainly attributable to early medical discharges. Conclusions: Multidisciplinary teamwork and the cooperation of key persons in the system made it possible to discharge more patients within half a day. Use of clinical information storage and retrieval systems were essential for coordinating efforts and automating tasks in real time. The plan also represented an important cultural shift in our planning of hospital discharges. [Emergencias 2011;23:29-34]