1. Discharge to Door Kaizen #3

2. 2 Team Nurse Practitioner: Nurse: Pharmacist: Hospitalist: Radiology: Care Manager: Social Worker: Home Health: Accounting: PI Coach: Patient: Palliative Care:

3. 3 Event Expectations 1.Document Current State Discharge Process 2.Develop a Future State Discharge Process 3.Capture “Before” Event Metrics 4.Create Discharge Audit Form & Team 5.Develop Action Item List 6.Develop Final Presentation

4. 4 Current State Flow Chart

5. 5 Discharge Order Written Nurse Secretary discovers discharge order in chart First time anyone knows discharge is eminent

6. 6 Major Blocks ClinicalHousing, Meds, Transportation 1 st 4 HoursNext 4 + Hours

7. 7 Current State Flow Chart Care Manager & Pharmacy Social Worker Bedside Nurse Discharge Order Nurse Secret- ary Charge Nurse Care Partner

8. 8 Current State Flow Chart Care Manager & Pharmacy Social Worker Bedside Nurse Discharge Order Nurse Secret- ary Charge Nurse Care Partner

9. 9 Data Analysis 59 Patients chosen at random from thousands January patients chosen since their records would be complete Measuring time from Doctor’s (discharge) order to time patient was checked out of system

10. 10 January 2010 Data 9.1 Hrs 8.4 Hrs7.6 Hrs6.3 Hrs 5.0 Hrs4.5 Hrs

11. 11 January 2010 Data 47% 53% 1 st 5 HoursHours 6 - 33

12. 12 January 2010 Data Noon

13. 13 30 Day Action Items ItemActionOwnerDue 1 Flag D/C patient’s charts & review immediately after STAT charts Julie 2 Develop standardized D/C process for use hospital-wide Robert 3 Process all ancillary orders as STAT Debra 4 Scan D/C Med orders STAT Shelly 5 Develop & Beta test “white board” Stephanie 6 Case Manager & Social Workers begin preparing multiple placement options Darlene

14. 14 30 Day Action Items (2) ItemActionOwnerDue 7 Develop & use D/C checklist for all disciplines Robert 8 Print In-Patient Med labels for use post discharge (avoid re- labeling) Shelly

15. 15 Future State “Pending Discharge” Order (24 Hrs in Advance) Social Worker Bedside Nurse Nurse Secret- ary Charge Nurse Care Partner Clinical Dis- charge Care Manager Pharmacy

16. 16 Event Outputs √ √ √ √ √ X Document Current State Discharge Process Develop a Future State Discharge Process Capture “Before” Event Metrics Create Discharge Audit Form & Team Develop Action Item List Develop Final Presentation