Abstract 13953: A Quality Improvement Initiative Increasing Early Discharges for Cardiovascular Surgery and Cardiology Patients on the Acute Care Cardiology Unit Was Associated With Reduced Hospital Length of Stay

Introduction: The discharge process in the acute care setting is a complex process composed of many parallel and sequential steps. Safe and timely discharges improve patient throughput. Early discharges off-load full ICUs and improve transitions to the outpatient setting. Review of our data demonstrated the majority of discharges occurred later in the day. We set out to improve our discharge times for cardiology and cardiovascular surgery (CVS) patients on our 26-bed inpatient acute care cardiology unit (ACCU) Hypothesis: Smart Aim: Increase the number of discharges between 6 am and 12 pm for cardiology and CVS patients on ACCU from 5 to 10 patients per month over 12 months and to sustain. Methods: We performed a Failure Mode Analysis to highlight the steps of the discharge process and identify opportunities for improvement. Our key drivers centered around education, documentation, and planning. Our interventions included: education of front-line staff, communication of discharge expectations, daily quality board rounds, hospital-wide collaboration emphasizing conditional discharges, and hospital IT improvements. Statistical process control charts were utilized to analyze the data. Results: The number of discharges between 6am and 12 pm more than doubled from a baseline of 5 (8%) to 12 (18%) patients per month with a centerline shift. As part of our process measures, appropriate conditional discharge usage linked to earlier discharges. Upgrades to our EMR discharge system further increased our timely discharges. Our efforts resulted in 22% reduction of hospital length of stay from 11.1 to 8.7 days without an increase in readmission rates suggesting that improved efficiency did not impact care quality. Conclusions: We successfully show how multidisciplinary collaboration and systems-based improvement can increase the number of safe, early discharges.