Speeding Patient Discharges Safely at Yale-New Haven Hospital

Nurse directors quantified reasons for variances. Unit huddles were conducted three times a day for 10 minutes to review which patients were going home and which could go home if barriers were overcome, such as nursing home transfer or organizing rides home.

Here are the results achieved during a two-year period starting in July 2008:

• ALOS decreased from an average 5.23 to 5.02 days YTD through June 2009.
• LOS in ED for patients being admitted was decreased by 25 minutes, despite significant increases in ED volume
• Percentage of discharges by 11:00 AM were increased 50% from 12% to 18% on average
• Median time of discharge was decreased by 45 minutes
• Post-Anesthesia Care Unit length of stay decreased by approximately 25 minutes and showed further improvement in the last nine months
• Bed turnaround time was decreased by 35 minutes on average for priority 1 bed assignments
• Patient transport time remained within 30 minutes despite the addition of a new Cancer Hospital Pavilion

Figure 1 illustrates YNHH's SPF results. To view it, click here.

Proper Staff Support and System
The opportunity analysis set up targets and time frames relating to performance gaps in current processes. The seven-person Operations Support (OS) Department provided consulting, behavior audit, support, and coaching. Execution controls were established to allow managers to monitor and prioritize assignments for both clinical and non-clinical managers. Daily operational supports gave a balanced set of key performance indicators, comparing actual to planned performance.