Student Dissertation

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

Objective : • To study the process of discharge at Sterling Hospital, Bhavnagar. Specific: - • Identify the cause of delays to discharging patients from the Inpatient Department and develop interventions to minimize such delays. Data has been collected using National Quality Assurance Standard checklist • To understands the bottlenecks. • To study the barriers / delay in discharge process. To reduce high TAT of discharge. • To propose recommendations based on the study findings.

Background : Discharge by definition is to formally terminate a patient care, and releasing him/her from hospital or healthcare facility. A patient is discharged only when he/she has recovered fully or satisfactorily according to the concerned physician. Discharge is a very complex process it involves several stakeholder. It is one of the major key factor for patient satisfaction and revenue generation for Hospitals. There is often a significant delay between a patients being identified for discharge on the ward round to actual discharge from the unit. ‘Discharge delays cause patient flow constraints which negatively impacts patient satisfaction, safety, hospital capacity and financial performance’.

Methodology : • Location of study o Inpatient department of sterling hospital, Bhavnagar. • Study design o Mix of qualitative and quantitative. o Sample size o 120 cash patients. • Sample technique –probability sampling. (CONVENIANCE SAMPLING) Data collection technique • Primary data collection. • Tool – check list (patient discharge checklist). • Technique –observation

Findings : From the study it was observed that the delay in the discharge process can be optimized by implementing the discharge tracking list along with recommended suggestions. Discharge tracking list can give instant idea about the problematic areas and one can easily recognized and can work upon without going through all the complex process. The study shows that the delay in the discharge process can be reduced more than 50 % by working on each step of discharge process which ultimately improves the overall process.

Recommendations : 1. Advance information: - Advance planned discharge by physicians so that the nursing staff can prepare accordingly. 2. Trained nurses to prepare discharge summary: - because typist are not available on every floor. 3. Discharge summary is typed from the day when patient is admitted to the hospital: -. The discharge summary is typed from the day the patient is admitted, is updated on a daily basis and on the day of discharge, only minor additional information is added. 4. Daily updating bills: - To speed up of the billing process and to ensure quick turnaround of the final bills, all bills are audited and updated every night to ensure minimum time is taken on the day of discharge. The aim is to complete all the discharges before 11am every day, so that the same beds could be made ready for the new admissions. 5. Upgrading IT: - To ensure speedy processes, IT systems too were upgraded. Some automation in the Hospital Information System (HIS) was brought in to enable a faster billing process as well as availability of diagnostic reports online which ensured that there was minimal delay 6. Daily Payment: It is not easy to ensure that the attendants are ready with the balance of the payment and logistic arrangements.