Erum Gonsalves
Aga Khan University, Pakistan
Title: Re-engineering the hospital discharge process: An upsurge in service efficiency and patient serving capacity
Biography
Biography: Erum Gonsalves
Abstract
Statement of Problem: The Business Process Reengineering Team conducted a redesign of the Inpatient Discharge Process at a 660-bedded hospital in the largest metropolis of Pakistan. The study aimed to optimize bed utilization by ensuring 85% discharges before 2pm. Analysis revealed that, discharging patients was not a priority for medical teams and significant delays in discharging patients was result of an inefficient process. Additionally, there was weak communication between medical and administrative teams, delays in doctor rounds, bill finalization, lab and radiology workups, pharmacy preparation and patient logistics. The discharge process took up to 8 hours, of which 70% time was spent in non-value adding activities. The hospital was losing 240,000 bed hours annually.
Methodology & Theoretical Orientation: The project was completed in three phases, analysis, redesign and implementation. The analysis and redesign was completed over a period of 8 weeks each both phases involved extensive primary and secondary research, detailed interviews from more than 60 medical and administrative teams selected randomly, on ground observations for detailed process mapping of patient journey from admission to discharge was done using sticky notes and MS Visio. Data were extracted using HIS system and manually collected using time and motion study, which was then analyzed using MS Excel. BPR Team identified the need to automate pre-discharge communication to facilitate an efficient and seamless discharge process. Over the course of 1 year the BPR team worked in collaboration with hospital and administrative team to facilitate implementation of proposed changes.
Findings: The percentage of patients discharged by 2 PM increased substantially from 9% to 33% during the pilot and went up to 86% after the final 2 PM checkout time was implemented in February 2017.
Conclusion & Significance: Minimizing inefficiencies in the discharge process resulted in reduction in the discharge process time by 2.16 hours per patient. This translated into savings of over 100,000 bed hours annually, thus allowing the hospital to efficiently allocate its resources and create capacity to serve more patients.