Abstract of Dissertation

Agency : Discharge Process, Discharge Time, Patient Satisfaction

Objective : • To study discharge process flow in the hospital and time taken at each step. • To find the steps of discharge process in which delay is occurring and their reasons. • To streamline the discharge process reducing the time for discharges.

Background : Discharge can be broadly defined as ‘the processes, tools and techniques by which an episode of treatment and/or care to a patient is formally concluded by a health professional, health provider organization or individual’. It involves the development and implementation of a plan to facilitate the transfer of an individual from hospital to an alternative setting/home where appropriate. Discharge time has important implications on the hospital working as it affects patient satisfaction, utilization of hospital resources, revenue generation, timely access to inpatient bed, assured continuity of care. The standard of discharge management impacts on hospital efficiency, quality and safety of patient care. The hospital is facing problem due to delay in discharges which is leading to patient dissatisfaction. It was also causing unavailability of bed for new admissions. There was lack of clear communication and coordination between disciplines. Process for discharge was not streamlined .So it was important to analyze the bottlenecks and take preventive and corrective actions to improve the process.

Methodology : Type of study: Cross-sectional, Prospective and Analytical study. Study duration: Feb to April 2014 Study area: Data has been collected for discharge patients taking place in hospital at the time of study from wards, billing department, Insurance desk, corporate cell and inpatient pharmacy in the Apollo hospital. Sample: 150 sample size (which includes Cash, Corporate and Insurance patients). Data collection tool and techniques: Data was collected by observing time taken at different steps. For this discharge tracking sheet was prepared for major steps and time was recorded from respective study areas.

Findings : From the study it was found that there was delay in the discharge time. Number of Patients who were discharged after scheduled time was more than that before scheduled time. Discharge time for cash, corporate and insurance patients was also exceeding the norms of the hospital. Discharge process steps were analyzed and reasons of delay found were late round of consultants, delay in correction of discharge summary, delay in insurance clearance, delay after billing settlement when patient is not prepared for discharge, and delay in arrival of stretcher.

Recommendations : Patients with delayed discharges were common. Reasons of delay were analyzed and recommendations were given to reduce delay. If recommended measures are considered valid and applied in the system, the duration of time can be greatly reduced. Discharge intimation form and discharge checklist for patients and caregivers was made and recommended for implementation to reduce delay and enhance quality of discharge process. An improvement in the discharge procedure will increase the patient satisfaction immensely as discharge is observed to be one of the most common reasons for dissatisfaction amongst the patients. For effective discharge planning family, hospital staff, doctors, nurses must work together, performance standards should be frequently monitored and there should be openness to innovative solutions.