We have also struggled with patient throughput and have implemented a number of initiatives.
Having Hospitalists round on patients that are likely to be discharged first thing in the morning.
Hospitalist writing the discharge order the day before likely discharge so that all team members or aware and can prepare the patient/family.
Expected date of discharge (EDD) on white boards in the patients room so that patient and family know what to expect.
Addition of further information on the White boards at the main nursing station so that barriers to discharge can be addressed early.
We also experimented with a discharge lounge, where patients that were discharged but had delays in pick up could wait.
Get the physicians involved early so that they are part of the process from the start. Find out what they need to be successful, leadership training, support from admin, even the importance of the date/time of the meeting based on the physicians clinical schedule. Doc’s want data to support the reason for the change, set meaningful targets, and monitor progress.
We have a psychiatric crisis unit in our ED. This is staffed by a psychiatric RN and RPN. After being medically cleared by the ER physician, they are assessed by the psychiatric RN or RPN. Those patients that require admission or further assessment are seen by the on call psychiatrist, patient that do not require admission are discharged by the ER physician. The model allows for a separate area for these patients to be assessed. This unit has two interview rooms and three rooms with a bed. Some patients that need observation, or a period of de-escalation but not necessarily admission are held in this unit overnight.
We are a level 1 psychiatric hospital which means we get patients transferred from our surrounding 4 hospitals. Because we are often full, these patients often have delays in transfers as you are describing at yours. We are now using OTN (ontario telehealth network), where the psychiatrist can assess the patient via OTN and determine whether they actually need transfer to our facility. Not sure if this is an option for you and whether some of your patients are actually discharged once they arrive at your state run facility.
Discuss with the physicians by specialty what they feel would be valuable to them to have on the dashboard. They may come up with items that you hadn’t considered but what physicians would find useful for quality indicators and to compare themselves to their colleagues. Whatever is selected for the dashboard must be accurate, reliable, and reproducible.