Children's Hospitals Today - Fall 2021 - 23

IMPROVEMENT / FEATURE
for every 48 patients discharged, the
ALOS would reduce by one day.
Introducing a team concept
Using that hypothesis and patient and
family feedback suggesting the discharge
process should take an hour or
less, the team began to formulate Team
Discharge. First, the team looked for
common themes among discharge delays.
What they found among the intraand
interdepartmental communication
breakdown was a lack of notifications
when something was wrong or missing.
Similar to heart monitors and other
devices that alert clinicians to changes
in patient status, communication breakdowns
could be remedied with an alarm
in the medical record. But during this
age of alert fatigue, the team struggled
to implement one more alert.
Next, the team decided to align resources
around a teamwork model that
reflects the makeup of a softball team,
where everyone has a role and responsibility
associated with a process. This
would allow the timeline of activities
after discharge orders were entered
into the medical record to be synchronized
and aligned with the goal to discharge
patients within an hour.
To accomplish this, the team involved
the unit coordinator to use the
overhead pager system. Using a script,
the coordinator notified clinicians of
the pending activity and oriented them
to the location of the activity. Those assigned
to the area where the discharge
was announced then could sync their
watches to know what task to complete
based on their job title and when
they needed to complete the task.
To complete the design of Team
Discharge, the group fixed communication
breakdowns within the process
and built a model that put patients and
families in the driver's seat of care. The
team created instructions similar to
a map, titled " My Journey Home, " that
contained seven learning milestones
the patient and family should retain
before discharge. The clinicians used
the map to guide discussion and assess
the patient's and family's knowledge.
This hardwired the concept that disorganization
successfully reduced
discharge processing times by 31%
(94.3 minutes at baseline, currently
65 minutes on average). The team also
was able to reduce the hospital's ALOS
by 14.4%, beginning at 5.62 days and
currently 4.81 days.
By empowering team members to
facilitate change and to have leadership
support those changes, the team
at Children's Hospital of The King's
Daughters fostered a culture where
change is welcome. Adding feedback
from families has also improved relaGenchi
gembutsu
Go to the location where work is happening,
observe quietly, and learn the process to
uncover the problems.
charge begins upon admission because
clinicians need to establish a baseline of
knowledge from the patient and family
to begin the use of the map. They also
engaged physicians to enter discharge
orders before noon. This would ensure
rounding occurred in the morning and
give patients who had met the seven
milestones time to discuss questions or
concerns with physicians during morning
rounds, before discharge.
Seeing results
After all elements of Team Discharge
were created, implemented, and
sustained by the frontline staff, the
tionships between team members and
families, and this is reflected in patient
satisfaction scores. This project has
sustained positive results over time
and continues to hold the gains. As a
result, where possible, the organization
now approaches problem-solving following
a similar team-driven approach.
Christopher Mangum, CSSBB, is director,
clinical improvement and analytics,
at Children's Hospital of The King's
Daughters in Norfolk, Virginia.
Send questions or comments to
magazine@childrenshospitals.org.
Collated and analyzed
information from the
observations.
Identified the discharge
process as biggest area
of opportunity.
Flagged inefficient
team communication
as a barrier to an
efficient process.
Formulated and
implemented an hour-long
discharge process to
reduce length of stay.
CHILDREN'S HOSPITALS TODAY Fall 2021
23

Children's Hospitals Today - Fall 2021

Table of Contents for the Digital Edition of Children's Hospitals Today - Fall 2021

Contents
Children's Hospitals Today - Fall 2021 - Cover1
Children's Hospitals Today - Fall 2021 - Cover2
Children's Hospitals Today - Fall 2021 - Contents
Children's Hospitals Today - Fall 2021 - 2
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