Mills Peninsula conducts bedside rounds with the entire care team at 4pm daily so everyone can be in sync and know the plan for discharge.
A lot of people are involved in the discharge planning process but it was challenging to keep everyone in sync. For instance, the doctor might decide that a patient is ready for discharge but not notify the rest of the team, so then the pharmacist wouldn’t have the medication ready or the physical therapist wouldn’t know to conduct their last visit with the patient. Or patients wouldn’t know when they could expect to go home, so they wouldn’t have transportation or home care arranged.
Mills Peninsula is a non-profit hospital in Burlingame, CA that has partnered with the Palo Alto Medical Foundation and Peninsula Family Services to develop the Peninsula Circle of Care program. The hospital has 241 beds and serves a primarily elderly population (average age of 81) living alone with 90% on Medicare. Peninsula Circle of Care, their transitions program, began in 2012 and is influenced by the Care Transitions Program and a community based model.
What We Tried
As part of the Lean process, we got a group of doctors, nurses, case managers, physical therapists, dieticians, pharmacists, and managers together to redesign the discharge process so that it was easier to coordinate care. The result was that we reframed our daily bedside rounds to be about discharge planning. We used to have rounds every day at 9:30am, but there was no clear focus to them. Sometimes they would be about the patient’s plan of care for the day, or about lab results, or new medications. It was also too early for anyone to make any discharge instructions.
Now every patient has a Progress Towards Discharge (PTD) checklist with their discharge plan. We also moved rounds to 4pm hospital-wide so that we had the necessary information to discuss discharge. At these daily rounds, the entire care team discusses which patients are ready for discharge and which activities need to happen before they can go home. For example, if a patient needs to receive an education on diabetes, the nurse makes sure the diabetes team has seen the patient. All of this happens in front of the patient and their caregivers so that they are also aware of the discharge process.
The PTD form and discharge rounds at 4pm have really helped focus our process. Now the entire care team and the patient are always working toward getting the patient ready for discharge. The care team is more satisfied because they’re kept in the loop instead of having to tell patients that they have to ask their doctor about discharge. Patients and family are more satisfied because they have more visibility into their hospital stay.
Redesigning the process with the frontline employees was key. They understood the original process and were aligned with the changes since they, or a colleague in the same role, helped design it.