Removing Bottlenecks in Patient Discharge Process

The focus of this discussion is a large local multispecialty hospital. The hospital in question has a bed capacity of three hundred patients. In this institution, there are several bottlenecks that makes the process of discharging patients lengthy and challenging one especially when such dischargings are to happen, say, during the weekends and holidays. In fact, the procedure of discharging a typical self pay patient may take as long as six hours, and this proves to be strenuous to the recovering individual as well as to the members of his/her family. As a result, the once reputable hospital has been experiencing loss of clients and revenue due to the heightening frequency of complaints by both patients and the members of their families. Additionally, the lengthy discharging process limits the bed capacity thereby making it difficult to admit new patients. This is detrimental to the society and, besides, it ends up decreasing the amount of revenue making it difficult to grow or acquire new technologies.

The Principle Bottlenecks that Lead to Delayed Discharge

The first bottleneck among those that undermine the optimal operation in this great hospital is the delayed commencement of the discharging process. This is attributable to the failure of the management to create care plans with clearly spelt out lengths of stay as well as projected date of discharge. It is common to find the discharging process being set off unpredictably, in fact, just after the consultant declares the patient to be fit for discharge. This happens during the routine rounds, and it proves to be intriguing as the discharge was evidently unforeseen or, at least, predictable.

Secondly, an additional challenge during discharge is experienced during the completion of the patients’ discharge cards. This happens because most of these cards are handwritten, and the process of filling them begins just after the consultant has a signoff during the day of discharge. Furthermore, there are instances when, even after being approved for discharge, the patient is delayed at the facility since the relevant signatories cannot be traced in time. Some consultants, for instance, delay signing of the discharge cards; and this results into a situation where the cards are unnecessarily held in an office or two. This derails the discharging process, a scenario that hurts the patients (Langabeer 92).

There are notable delays in the completion of the final case file for dischargeable patients. The root cause to this challenge is that the case files are often not checked on a daily basis so that appropriate updating of the services that have been ordered for the patients can be done in time. Likewise, there is a delay in the preparation of the final bill which is occasioned by tendency of the wards delay until the billing files have increased to a certain number before they are forwarded for processing at the billing counter. Finally, there is a considerable delay during the financial clearance. This problem is brought about by the failure to immediately inform the attendants that the final bills are ready for computation. As a result there is usually late entry of charges, and this may lead into an increase in charges in the interim making the final bill questionable.

Recommendation for the Elimination of the Bottlenecks

In order to reduce the time taken during the discharge of patients, certain steps ought to be considered by the management. First, the management ought to device a system where the planning for discharge begins soon after the patient has been admitted. To this effect, therefore, the management of the facility should strive to put into place a care plan for all elective patients within 24 hours of admission. As such, the patient, his/her family, as well as the entire care team would be in a position to prepare for discharge when it is due. This will orient all the parties involved to start off the discharge predictably 24 hours before the discharge day arrives.

It would be of great benefit if the management enforced a daily updating of the discharge cards. This would alleviate the challenge that the medical staff goes through on when discharge day arrives. In order to maintain a high level of efficiency, those tasked with the responsibility of completing discharge summary should be required to accomplish their tasks within the shortest time possible, say, 10-15 minutes after discharge has been approved. The management should ensure that the patients’ case files are updated daily. This will ensure that the case files are in the required state when discharges are approved.

The hospital administration should also ensure that discontinued medications are returned to the wards on a daily basis. To this effect, therefore, there is a need to minimize the role that the pharmacists have to play soon after the patient has been discharged. This is because a significant amount of time is wasted when the patients are acquiring drugs at the hospital pharmacy. Eliminating the need to secure medication from such locations would significantly cut down on the duration of time that the patient spends during the discharge process. In addition, it is recommendable for the charges to be recorded at the very time and point that they have been accrued (Langabeer 96). This will undoubtedly help in the speedy generation of up-to-date interim bills. Besides the elimination of the errors that often occurs when the computations are hurriedly completed, the patients would find it convenient as they would not be delayed unnecessarily. 

Finally, it is recommended that the hospital administration embraces technology so as to realize quicker bill settlement. This can be achieved through the integration of an automatic SMS or email system that would enable the patients or their relatives to be updated on the developments as well as the outstanding bills. However, caution should be taken on this so that the hospital does not share the patients’ medical data with unauthorized parties. Should this happen, the hospital management may be tasked to answer charges in a court of law; and this would, in effect, result into time wasting and further derailment of service delivery at the facility. Therefore, the telephone numbers and emails should be those that have been provided and authorized by the patient or close family members.

Implementation

The implementation plan should be devised in a manner that facilitates its division into phases as such phases do act as milestones that boost the morale of those who are involved in the discharging process. Firstly, there is a need to conduct an interim discharge process in a ward using the existing resources with, possibly, minimal modifications to the health information that is normally handled at the hospital. This interim process would deliver significant improvements that would then act as the basis for implementing larger programs. Such an arrangement would ensure that the final process meets the target efficiently. It is, however, imperative for the hospital management to keep on evaluating the discharging process for the purpose of improving it. This is because new challenges arise with time, and neglect or delays may, actually, result into detrimental consequences to the entire hospital fraternity.