Intelligent Automation: Top 5 Recommendations to Achieve and Sustain Hospital Discharge Performance Excellence

Jason Harber, June 22, 2021

Effectively managing the discharge process is universally recognized for its impact on efficient patient flow and its bearing on unnecessary bottlenecks.

Although concept sounds simple: deliver efficient care, minimize delays, and discharge patients earlier than you do today; without the right processes and systems in place, it’s anything but that.

After nearly two decades working in hospital operations, capacity management and patient flow, I’ve had the opportunity to meet with hundreds of hospital leaders, observe the real-world experience and workflow of front-line teams, and understand the volume of data and decisions cross-functional teams require to effectively manage the discharge process. These top 5 recommendations are the culmination of that expertise, representing proven strategies to enable an effective discharge process, and ensure performance improvement gains remain constant and sustainable:

  1. Assign a Day-to-Day Operational Leader

This is a designated individual who owns the initiative and is responsible for daily throughput needs and the coordination of care by front-line teams. This cannot be a largely ceremonial title. This individual must have real authority or influence; be empowered to gather solid, reliable data from all areas; break down barriers; and be provided the tools necessary to design, test and implement improvements.

  1. Develop a Coordinated System-Wide Process

The organization as a whole must view the patient discharge process as a connected approach. Each patient’s care progression, as well as the impact to the enterprise as a whole, must be understood. Steps in the process cannot be managed in a silo and escalation protocols must be clear. This creates a system-wide process that is coordinated, proactive, and constantly adapting.

  1. Implement a System for Accurate Predictive Insights

Capacity crises and avoidably delays are largely preventable if care teams have the right data to take action in advance. Understanding anticipated census, identifying the day’s most impactful discharges, prioritizing units reaching or over capacity, and escalating situations that require hospital-level coordination puts everyone on the same page with what needs to be done to ensure 1) patient length of stay is not unnecessarily extended, and 2) beds are available for anticipated incoming patients.

  1. Identify Discharge Barriers and Provide Recommended Actions to Remove Them

The organization must identify potential discharge barriers and deliver specific action plans (at the system and at the unit level) to resolve them (e.g., classification, outstanding tests, post-acute needs and placement). This requires a synchronized approach across multi-functional teams so everyone knows what they need to do, has a timeline for when it needs to be done and understands the impact on other units and the enterprise as a whole.

  1. Eliminate Communication Silos

Once everyone knows what they need to do to ensure success, there must be an effective method to communicate progress and updates, and request support if needed. Manual communication methods like phone calls, written notes, text messages, emails, etc. are untimely, inconsistent and often siloed, causing items to be missed or work to be duplicated. All cross-functional areas must work from a “’single source of truth” to identify, understand, address and communicate status on critical priorities. And for front-line teams, everything must accessible in real-time from where they are, whether rounding with patients, in a huddle, or in a logistics center.

Achieving these best practices requires an enterprise commitment to discharge performance excellence along with having right systems in place to ensure success. Today, AI-based operations management systems are being used in hospitals and health systems of all sizes to deliver meaningful digital transformation to effectively enable each of these recommendations. The most effective platforms use intelligent automation to integrate data elements across systems; embed the data science of artificial intelligence (AI) predictive analytics, simulation, and optimization; and provide a digital, closed-loop communication platform for multidisciplinary team members.

By imbedding intelligent automation within current operating procedures; AI-based systems deliver predictive insights, recommend the most meaningful actions and streamline how work is done. Organizations that have adopted intelligent automation have achieved systemic and sustainable improvements in all operational areas including patient flow, capacity management, perioperative utilization and nurse staffing. For discharge practice improvement specifically, the benefits are clearly identified in decreased discharge delays, shortened lengths of stay, reduced emergency department boarding and more - for the benefit of the entire health system as well as each patient.

Using intelligent automation to support the hospital discharge process

Jason Harber, April 29, 2021

Discharging patients from the hospital can be like getting ready for a big game, everyone involved needs to understand their role.

An oversight, misstep, or lapse in communication can lead to a longer length of stay, unnecessary costs and one fewer bed for an incoming patient. Harber discusses how intelligent automation, the use of artificial intelligence, workflow automation, and communication to detect and mitigate risk and create action in real time, can improve discharge processes and take the burden off overtaxed staff members.

What do you see as one of the top hurdles hospital face in managing timely patient discharges?

Breakdowns in communication can be a huge barrier to timely discharges.

“A successful discharge requires that case management, nursing, hospitalists, outside physicians, and ancillary departments are all working toward the same end goal for each patient,” says Harber. This reinforces the need for efficient, ongoing communication within an environment that struggles to supports it. “Management teams are often separate and physically siloed, so collaboration is very difficult,” says Harber.

Some organizations will try to bridge this communication gap by performing huddles or multi-disciplinary rounds. “Although these events often occur daily, they rarely result in targeted actions to ensure a successful day, leaving care teams siloed,” says Harber. However, using technology to engage care teams in their daily work offers the opportunity to replace manual methods, enabling teams to align on priorities and coordinate discharge activities throughout the day, ensuring everyone aware of patient progress, and any potential roadblocks.

Are there any system-wide discharge practice improvements that hospitals should be adopting?

“The first thing I would say is to understand who the operational leader is,” says Harber. “When you ask who is ultimately responsible for ensuring that patients are discharged each day, very often those involved point the finger the other way.”

To solve this problem, some organizations have designated a point person to oversee the process. “The position is typically the director of patient throughput,” he says. A number of facilities have devoted resources to the position, which has the sole responsibility of coordinating discharges and ensuring patient throughput. In some instances, organizations have designed the position as a virtual nursing function, so the unit is separate, but always digitally overseeing discharge-related activities.

The second part is ensuring consistency in the discharge process across the health system. Properly managing capacity across the enterprise can help the organization achieve new levels of performance excellence, profitability, and patient care.

What are the benefits of using intelligent automation to optimize discharge practices?

Intelligent automation encourages communication between team members and can reduce length of stay and streamline processes to free up overloaded staff members. Supporting discharge processes with a robust technology platform can provide a pressure-relief valve. “If we can move the patients in the system more efficiently and find ways to collaborate safely and effectively to move them to the next level of care, it’s not only better for the patients, but it’s also good for your staff,” he says.

These advanced technology platforms can also help organizations reduce length of stay by anticipating and prioritizing discharges, and clear census-related bottlenecks that can occur when nursing units don’t know when new patients will arrive. Having a system that can alert staff members when patient demand is set to increase and automatically identifies patients who were supposed to go home yesterday, but didn’t, allows them to plan more effectively.

Missed discharges often occur because a patient was missing a needed medical test or a because post-acute transition wasn’t ready. “We use predictive analytics to identify missing tests, or to determine whether a patient will have a post-acute need as early as possible,” he says. Spotting potential barriers to discharge promptly allows them to be cleared before they impede the process.

What are some improvements and results you've seen with hospitals incorporating intelligent automation into their discharge practices?

“Clients using our platform are able to shave a half day off the average length of stay,” says Harber. Intelligent automation solutions also save time, and paper. Staff members can use a tablet, instead of a clip board, carrying it with them to work at the bedside. It also expedites work on the back end. “You could be talking about hundreds of hours of labor that would have been spent collating data and reviewing data that can now be directed toward patient care,” says Harber.

Advanced technology platforms can unify team members to work toward a common goal. “We embed messaging and social components into the platform,” says Harber. Users can send notes and tag others, to ensure alignment. “It’s a great way to get everybody focused on the same thing,” he says. Ultimately, intelligent automation helps discharge safely and efficiently. “If the system is faster, we can take care of more patients,” says Harber.

How AI and Predictive Analytics Are Enabling the Digital Transformation of Hospital Operations

Jason Harber, March 4, 2021

Each day, hospitals face stiff challenges in trying to ensure high quality patient care while balancing the constraints across the organization.

“It requires a holistic view to do it well, but the reality is hospital leaders still rely on a disjointed process of spreadsheets, phone calls, texts, and even faxes to make critical operating decisions,” says Jason Harber, executive vice president of operations at Hospital IQ. He says that digital transformation allows organizations to increase their situational awareness, automate business practices, and embed AI to improve decision making. Harber discusses how digital transformation platforms are helping healthcare organizations improve key areas that have suffered more financial pressure than ever before due to COVID-19 and other industry disruptors.

Q: What are some of the common operational challenges hospitals are facing daily?

A: Hospital leaders are balancing numerous challenges related to the management and coordination of their operations. Two great examples are coordinating patient discharges and nurse staffing due to the last-minute dynamics they face in a constantly shifting environment. The tools they use to ensure patients are seen at the right time and place by the right provider are very fragmented, and communication between leaders, staff, and teams are often siloed. COVID-19 brought these challenges to the forefront when hospitals were stretched to capacity in many regions of the country, which ultimately impacted the patients, as many communities struggled to gain access to care.

Unfortunately, front-line teams often don’t have the right information about current and upcoming capacity needs to align on the priorities across their various patient units (critical care, med/surg, behavioral, etc.) to effectively coordinate timely patient movements and relieve the organization of their capacity constraints. Additionally, nursing shortages—made worse during the pandemic—put even more stress on an already fragile system. Very few organizations have the tools in place to enable frontline staff to manage these dynamic situations appropriately.

Q: You mentioned that with the dynamic day-to-day operating environment, hospital leaders lack time and insight to make more efficient and effective decisions. What are these leaders doing to overcome the overall challenges?

A: As staffing and patient volumes, along with barriers to discharge, constantly change, leaders rely on phone calls, rounding, text messages, and even faxes to understand the constraints and make decisions. However, many are starting to realize this highly manual process is no longer sustainable. They are looking to create “systemness,” the coordination of multiple operating units that, when working together, create a network of activity that is more impactful than any action of individual units themselves.  Unfortunately, they simply don’t have the technology to drive the level of efficiency that is needed to operate in today’s complex healthcare environment. Organizations often try to rely on their EHR and existing IT systems, business intelligence tools, performance improvement teams, and consultants to support systemness, but ultimately they are finding it is not enough, and they are looking for more advanced technology to overcome these challenges

Q: Explain how AI-enabled machine learning and predictive analytics play a role in streamlining operational efficiency?

A: AI and predictive analytics work inside of daily operational processes to provide targeted information to decision makers in areas such as patient throughput and staffing. This combination of capabilities, known as intelligent automation, gets the right information, with the right action, to the right person hours, days, and weeks in advance, ensuring alignment of actions and priorities across the enterprise. The result is a new level of peak operational performance that will not degrade over time. So, we are implementing standardized processes and replacing manual and ad-hoc communications with AI-driven insights that can show everything from today’s discharge priorities and associated staffing needs to potential organizational bottlenecks up to seven days in advance.

Q: What are some of the outcomes you've seen with hospitals that are today using intelligent automation?

A: Our clients are seeing amazing results in how they manage patient discharge and staffing practices. For example, our discharge management customers commonly shave ½ day off their length of stay, discharging patients earlier than ever before, which not only reduces the cost of that patient visit, but also opens up a bed for the next patient. Clients focused on improving their staffing practices have seen impressive results as well. When healthcare organizations begin balancing staff more proactively, they can free up hundreds of hours of time across their nursing leaders each week, reduce premium pay, and increase staff satisfaction. These improvements not only have a positive impact on strategic KPIs and the bottom line for the hospital, but they also improve the quality of care provided to the patients.