Speeding Patient Discharges Safely at Yale-New Haven Hospital

Physician Engagement
YNHH augmented the consultant team (which lacked physicians and nurses) with a team of two physicians, one nurse, one pharmacist, and one financial analyst). Different service lines wanted to "own" their own beds. Centralized bed placement was more effective in reducing wait for the Post-Anesthesia Care Unit (PACU) and for the ED.

For the first year, the Associate Chief of Staff was Chair of the Steering Committee. He explained to physicians the basic premise to reduce crowding of the PACU and the ED by discharging patients earlier in the day. When patients were admitted later in the day house staff could not treat these patients promptly. There was a poor match of resources, as house staff was needed for discharge summaries, prescription orders and counsel on post discharge care. The early discharge initiative conflicted with the scheduled teaching program.

Under the SPF initiative, the discharge process now begins the evening before the scheduled discharge. Residents huddle together and identify patients likely to leave and put together elements to facilitate earlier discharge, such as notifying the family.

Green, yellow, and red indicators are used the day before discharge to predict likely readiness for discharge the next day.

• Green indicates very likely to be discharged the next day
• Yellow indicates clinically ready the next day but this readiness will be contingent upon, for example, the ability to tolerate a diet or pending laboratory results.
• Red indicates not likely to be clinically ready for discharge the next day and/or an appropriate disposition is not available

The disposition requires that the interdisciplinary team be in close communication regarding both clinical status and appropriate disposition resources. Success in reducing waiting times generated cascading support for the SPF initiative.