Student Dissertation

Agency : Hospital Discharge Process; In-Patient Discharge Process; IPD Department; Turnaround time

Objective : • To analysis the current discharge process, finding out the deviations in the turnaround time. • To compare the reasons behind the deviation in time taken with respect to the standard turnaround time as per guidelines

Background : The study was conducted in the IPD department of Wockhardt Hospital, currently functioning at a total bed capacity of 89 beds and would be scaled up to 350 beds. The hospital has been functional since July 2014. One of the problems that were currently being faced by the hospital was delay in the discharge process that majorly led to customer dissatisfaction. Even though most of the discharges were cash based, the process would take a lot of time. Hence the study was done to understand the causes of delays and to come up with a standard process of discharge.

Methodology : A cross sectional analytical study was conducted by breaking down the process into small processes and time was noted for each sub processes. Based on the sub process a tracker was created for each stakeholder and time was jotted down. To prevent any errors, instructions were given to note the time on the computer system. A sample size of 122 was calculated based on the formulae of random sample calculation and a population of 150 discharges was calculated based on average of discharges of the past three months.

Findings : It was found that the major cause of delay was the finalization of the discharge summary. At an average the time taken for discharge summary finalization was half of the total time taken for cash based discharges. As there were a lot of stakeholders involved in the process, it was found that a delay by one of the stakeholder would result in a delay of the entire process. It was also found that average time taken by planned cash discharges was more than the unplanned cash discharge. This paradox existed because the consultants didn’t inform the nurses about the medication and would take a round before discharging the patient. The essence of a planned discharge is prior knowledge of medication, which results in medication order a day prior and ultimately leads to a faster discharge.

Recommendations : Overall it was found that as most cases were planned discharges, a mere transfer of information of discharge medication a night prior could have a major impact on the time taken for discharge process