Research published online in the Journal of Hospital Medicine shows how quality improvement incorporating Lean Six Sigma, rigorous, problem-focused process improvement methodologies, improved pediatric hospital discharge times. Michael J. Beck, MD, FAAP, SSGB, chief of the division of pediatric hospital medicine at Penn State Hershey Children’s Hospital in Pa., and Kirk Gosik of the department of public health sciences at Penn State Hershey College of Medicine assessed the impact of these methods on times from placement of discharge orders to discharge from the hospital, along with secondary outcomes of length of stay and readmissions rates.
“The process and structure of going through rounds and discharging patients wasn’t working. Based on a lot of calls from the ER, we decided to try a one-month pilot of restructuring the daily rounds to improve throughput.”—Michael J. Beck, MD, FAAP, SSGB
“In our hospital, we did not have enough beds for what we were being asked to accomplish,” Dr. Beck says. “The process and structure of going through rounds and discharging patients wasn’t working. Based on a lot of calls from the ER, we decided to try a one-month pilot of restructuring the daily rounds to improve throughput.”
Reengineering included reallocating staff and creating a standardized work flow and discharge checklist. The rounding team was split into two smaller teams, with patients planned for discharge that day seen first and the necessary discharge paperwork entered into the electronic health record during the rounding.
The new process resulted in significantly faster times for order entry and for actual patient discharge, with a larger proportion of patients discharged before noon and before 2 p.m. The project has continued, using a PDSA (plan/do/study/act) process to advance and consolidate its gains. It appears to be sustainable, Dr. Beck says, and 13 months of data were to be presented as an abstract at HM15 in National Harbor, Md.
Larry Beresford is a freelance writer in Alameda, Calif.
