Background: Denver Health (Colorado) focusing on continuously improving healthcare system by finding ways to improve patient care and hence, control costs (Source: http://asq.org/qualitynews/qnt/execute/displaySetup?newsID=9324)
Problem Statement: Existing design of standard operating procedure for discharge of mother and newly born baby posed the following problems(identified as wastes)creating process inefficiency and customer inconvenience:
1. Unnecessary additional time mother and baby spend waiting for discharge (Paper work completion and other formalities)
2. Unpredictable flow from labor and delivery to discharge of mother & baby, & delays in length of stay in labor and delivery in excess of 3 hours
3. Fragmented clinical consultations at time of discharge
4. First discharges not occurring till 11 a.m. and often did not start early
Issue to be mitigated: More effective discharge process in order to decrease the length of patients stays - mandated norm of 48 hours. (Longer stay means delaying on the comfort of a home environment for patients)
Target Segment: Allow mothers to leave early who faced no complications in delivery and the baby was healthy.
Need of the hour: For this, proper coordination was needed among nurses, pediatrician, obstetrician & patients. Also, criterions for discharge needed to be revised to fast track early discharge.
How goal was achieved: 5 patients per day were released by noon after changing the discharge criterion via formation of RN/healthcare partner discharge pair (Purpose: To identify standard work and assign-discharge ready patients. They created criterion for a priority, fast track patient group for early discharge)
Cost saved due to process design change:
1. Increasing bed availability on the obstetrics ward as a result of earlier discharge reduced the upstream bottlenecks in OB, screening rooms, and labor and delivery rooms.
2. Less enquiry and waiting of patient’s family, thereby making the staff available for new incoming patients
3. Simple fulfillment of new criterion laid down for patients allowed the early discharge, without investment in infrastructure & employee cost
4. Good word of mouth publicity for the hospital via existing patients
5. Less parking space occupied by vehicles of the patient’s family
Final Result: The team increased the % of patients transferred from labor & delivery to post-partum care discharge in less than 3 hours from 40% to 85%. As a result, the capacity was increased from 3,800 deliveries a year to 4,350 without adding resources, with a projected revenue enhancement of $ 1.5 million.
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