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Implementation of the Discharge Hospitality Center to Impact Patient Throughput Karin Smith DNP, RN, CCRN-K

OSF Saint Francis Medical Center, 530 NE Glen Oak Avenue, Peoria, IL 61637 � kbsmith@bradley.edu

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Phase One: PCT Led 2

Phase Two: RN Led 3

Key Facilitators & Barriers 6

4 Phase Three: Patient Discharge in the DHC

Background Understanding system-wide constraints is critical to improving the

efficiency and effectiveness of hospital operations. Improved inpatient flow throughout OSF Saint Francis Medical Center (OSF SFMC) will

help mitigate issues such as diversions, leaving without treatment, elopements, and patient boarding in the Emergency Department (ED).

When inpatient throughput is efficient, inpatient and ED beds are utilized appropriately, capacity constraints are eased, and staff workload intensity decreases. The implementation of a Discharge Hospitality Center (DHC) on December 14, 2015 at OSF SFMC is one solution in which discharged

patients will be properly placed while waiting for transportation or services that can be rendered outside the acute care setting, thus

expediting the transfer of acutely ill patients waiting in the ED for inpatient rooms.

• Opened December 14, 2015 • “Pull System” • Specific patient criteria • Communication Ticket • Operational Guidelines • Patient exit surveys • Simulation prior to launching pilot

December 2015- May 2016: Average daily census of the DHC by week averages approximately two patients a day after 110 days of

operation.

•  Started pilot May 16, 2016

•  Two RNs and a PCT staffed in the DHC 0800-1730, Monday-Friday

•  Target departments with capacity constraints

•  Facilitate discharges on units

•  Transfer patients to DHC that meet criteria

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RNPilot1(5/16) RNPilot2(5/23) RNPilot3(5/31) RNPilot4(6/6)

DHCRND/C'sVS.TotalPa=entsServed

DHCRND/C's Pa=entstoDHC TotalPa=entsServed

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22Avg. 1.5 0.8 2.2 2.8 1.7 1.8 2 2.2 2.2 2.6 2.4 1 1.6 1.4 1.2 2 1.4 2.4 3.8 2.6 3.2

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0.8

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1.71.8

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2.2 2.2

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1.6

1.4

1.2

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1.4

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3.8

2.6

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CENSU

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WEEK

AverageDailyCensusbyWeek

May 2016- June 2016: Significant increase in average daily census of approximately seven patients in the DHC.

•  Started pilot January 2017

•  Two RNs staffed in the DHC 0800-1730, Monday-Friday

•  Identify patients that meet criteria and complete discharge in the DHC

•  Target goal is 80 patients a week or 16 patients a day

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OverallDHCWeeklyNumbers

February 2017-June 2017: Average daily census of approximately 13 patients or 63 patients a week in the DHC.

Facilitators: •  Commitment of the interdisciplinary team •  Coordination of services based on clear and consistent communication and documentation of all verbal conversations •  Development of a strong implementation plan and workflow process •  Simulation prior to Pilot One

•  Support and buy-in of the OSF SFMC business leaders and project sponsor •  Data collection and analysis that led to problem statements

Barriers: •  Resistance to change •  Clinician buy-in (especially when census drops) •  Department RNs wanting to control workflows

Suboptimal patient flow has many consequences in terms of quality and safety and financial and operational performance •  The potential adverse patient consequences are compelling reasons to work towards eliminating variability in patient flow

5 Outcomes

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Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16

Total # of Diversions DHC

Opened

Phase 2

DHC Opened

Phase 2

Overall decrease in the number of ED boarders and diversions from FY 2015 to FY 2016.

Acknowledgments: Christina Garcia, PhD, RN Kelly Cone, PhD, RN Jennifer Hopwood, DNP, RN, NE-BC Jill Crawford, DNP, RN, NEA-BC Kristin Crawford, MBA Kristie Haage, MSN, RN