Implementation of standardized workflows to reduce inpatient length of stay for medical oncology patients
| Autor: | Joseph Hooley, Kimberly Primm, Curt Westrick, Cheryl M Carrino, Chad W. Cummings, Michelle Brusio, Heather Koniarczyk |
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| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 37:80-80 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | 80 Background: Reducing length of stay (LOS) is an important initiative for hospitals for both clinical and financial reasons. Patients who are hospitalized for extended lengths of time may be more susceptible to hospital-acquired infections and other complications. Reducing LOS can also decrease cost of care and allow for more streamlined patient throughput. Our institution sought to evaluate opportunities to reduce LOS for our medical oncology patient population. Methods: Several interventions were implemented to streamline discharge planning. The structure of rounding was evaluated and standardized on each inpatient oncology unit to ensure that it was multidisciplinary and occurred each day at an established time. A process was established for Advanced Practice Providers (APPs) to write prescriptions the day before discharge (delivered directly to the bedside), and for APPs to begin discharge of patients early the following morning with use of a new discharge checklist. Standardized workflow was also created for instances where prior authorizations were required for prescriptions. We partnered with our Home Care providers to streamline the process for patients anticipated to be discharged to that service. Partnership was also established with physical therapy (PT) to avoid ordering low-value consults and to provide enhanced education to nursing staff about early patient mobility. Another project is being piloted to move lab draws six hours earlier the night prior to discharge. This provides the medical team additional time to assess and treat based on lab results if the patient required blood product transfusions or electrolyte replacement prior to discharge. Results: Implementation of interventions began throughout the first several months of 2019. Each of the first four months of 2019 saw consecutive improvements in both observed average LOS and LOS observed-to-expected ratios. Overall, a 2% decrease was seen in both of these metrics when comparing January to April 2019 to the 2018 baseline. Conclusions: Implementing several interventions to streamline workflows and processes leading up to a patient’s discharge can be effective in reducing both overall LOS and LOS observed-to-expected ratios. |
| Databáze: | OpenAIRE |
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