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Speeding Patient Discharges Safely at Yale-New Haven Hospital

Richard D'Aquila, Peter Follows, Michael Zaccagnino, and Anthony R. Kovner, PhD, for HealthLeaders Media, March 29, 2011

How can hospitals increase efficiency by assuring greater throughput to avoid building more beds? And how can they do so while improving safety, quality, and patient and staff satisfaction and finances?

These were the questions at Yale-New Haven Hospital, where discharges were slowed by a backlog of patients resulting, in part, from physician recruitment and program development that had temporarily outpaced facilities development.

Because discharge is one of the hospital measures for its performance incentive program, common for all employees and managers and representing 80% of the annual performance bonus, YNHH was motivated to facilitate speedier discharges.

Framing the Process Properly
Richard D'Aquila, YNHH COO, actively led the new initiative. A multi-disciplinary steering committee was appointed as the ultimate decision-makers. Nursing leadership conducted weekly meetings prior to steering committee meetings. Safety was the first priority.

A second priority was "actively managing" organizational resources. Active management includes setting clear expectations, assigning work, and identifying variance and performance issues in real time. Frontline leaders and employees met daily to review schedules ("huddles") and daily operating reports. Accountability was data-driven relative to targets and time frames.

Pre-engagement, a consulting firm, Carpedia, carried out an "opportunity analysis" to identify areas of particular gain, in terms of quantifiable financial results. This took five consultants up to three weeks to complete.  Outcomes were set for each functional and support area, for example: room turnover time (for Environmental Services) and turnover time (for Patient Transportation). The consultants identified the main database indicator as average length of stay (ALOS) reduction from 5.23 to 5.02 days—primarily for adult medical and surgical patients.

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