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Neurology team enhances discharge process

Aug. 11, 2016, 8:26 AM

More people needing neurology care can be admitted to Vanderbilt University Hospital after a team of employees eliminated delays in the discharge process to make beds available sooner.

The team achieved a 61 percent reduction in the time general Neurology patients remained hospitalized without a medical reason.

The multidisciplinary team pinpointed problem areas, charted them out as “storm clouds” and implemented action plans. Hospital Chief of Staff C. Lee Parmley, M.D., J.D., said the effort was a perfect example of the effectiveness of “having the people who do the work design the work.”

The team identified 55 storm clouds and devised solutions for 44 of them.

The solutions ranged from storing wheelchairs in closer proximity to changing the way neurologists do rounds. Instead of going room to room, neurologists started prioritizing those patients available for discharge.

“We see the sickest patients first, but then we see patients who are either being discharged today or might be discharged today to facilitate getting them out of the hospital in a timely manner,” said Adam Nagy, M.D., a Neurology resident.

A key factor for making this change work entailed having residents take part in the morning discharge huddles and then report back to supervising physicians.

“By residents being there, it has unified everybody who is involved in the patient’s care to optimize everybody’s work flow for the day, which is really a huge improvement,” Nagy said.

The new rounding model has the potential to be transformational if adopted by other units within the hospital, Parmley said.

The multidisciplinary team included physicians, nurses, social workers, speech therapists, physical therapists, occupational therapists, administrators and others. They met for four days to come up with solutions.

Early in the process, they focused on improving communication with colleagues about the benefits of reducing length of stay for individual patients.

“When we just harp on people to reduce the length of stay that’s not really meaningful to them,” said Candace Tillquist, M.A., MMHC, administrative director of Vanderbilt Neurosciences Institute. “But it is meaningful to them to know that they are going to be able to take care of more neuroscience patients who need our expertise.”

The average length of stay for a general Neurology patient was reduced from 5.82 days to 5.05 days. That difference, when multiplied by the number of patients in the unit, added up to the dramatic decrease in avoidable hospital days — the days patients remained hospitalized without a medical reason.

Once the changes were implemented, avoidable days decreased from 19 days per week to seven during May and June. The unit did not experience an increase in readmissions with the expedited discharge process, Parmley noted.

The effort followed a lean management model aimed at improving customer value and minimizing waste.

“It is about getting the people involved in the work doing the problem solving,” said Eric Lee, MBA, operations systems engineer for Vanderbilt University Medical Center.

“Once all the projects are implemented then that same group starts to integrate what we call lean management systems into their daily work flow to continue to identify and eliminate waste within the process.”

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