Transforming Hospital Discharge Processes Drives Better Patient Outcomes

Hospitals and health systems understandably invest a lot of resources in increasing inpatient transfers and admissions, but the effectiveness of many of these efforts is sometimes compromised by discharge delays. 

Often, discharge delays stem from unwieldy referral management processes to post-acute care (PAC), behavioral health facilities, or home with services. Discharge delays and throughput bottlenecks bring the potential to create a wide range of adverse effects for health systems, including frustrated patients and caregivers, reduced quality of care, and limited ability to admit new patients. 

In 2022, hospitals’ average adjusted expense per inpatient day stood at $3,025 nationwide, according to KFF. For hospitals, every unnecessary day of a patient stay has negative financial consequences and compromises effective care orchestration – the ability to deliver healthcare services precisely when needed in the most appropriate setting. 

To prevent throughput bottlenecks, hospitals and health systems must address shortcomings in the discharge process. Doing so requires streamlining and accelerating patient discharge through a multifaceted solution that involves three complementary and overarching strategies:

• Adopting proven processes and protocols
• Implementing purpose-built technology
• Empowering staff by reducing their administrative burdens 

What causes patient-throughput bottlenecks?

For most health systems and hospitals, among the most cited barriers to improving patient throughput are insufficient capacity and inadequate system load balancing. However, one frequently overlooked factor is the referral management process – specifically, delays in discharging acute-care patients to PAC facilities or home-based recovery. 

Factors that may contribute to acute care discharge delays include:

• Manual, paper-based PAC referral systems
• Siloed departments and disjointed processes
• Inconsistent discharge standards
• Lack of visibility to system-wide capacity and performance
• Prior authorization delays by third-party payers
• Patient transportation holdups
• Lack of data insights into PAC network acceptance, denial, and performance trends
• Inability to efficiently reach numerous PAC providers to discharge complex patients

Proven best practices for surmounting throughput barriers

Effective patient throughput helps ensure patients receive the right care at the right place in the right time. However, because of the increased complexity of the patient journey and growing difficulty in obtaining timely discharges, achieving this goal has become more elusive. Consequently, breaking down throughput barriers must be multifaceted and involve coordination among processes, technology, and people. 

From health systems that have overcome patient throughput barriers, the following best practices have emerged:

• Measurement and analysis – obtaining a clear picture of the patient journey to eliminate bottlenecks wherever they occur
• Discharge planning upon admission – laying out a clear pathway to discharge, with a backup plan, that’s embraced by the entire care team and communicated to the patient
• Multidisciplinary rounds – conducted early in the day, bringing together all stakeholders in patient care (hospitalists, nurses, pharmacists, physical therapists) to proactively identify the needs of patients and keep them moving on the pathway to discharge
• Cross-departmental collaboration – breaking down silos through technology-enabled information sharing, as well as through side-by-side work arrangements, such as embedding a care manager or social worker in the emergency department to help evaluate patients for the appropriateness of admission or discharge
• Advance transportation arrangements – notifying transportation vendors of upcoming discharges, helping to ensure timely patient transfers to the accepting facility
• Use of discharge lounge – when needed, moving discharge-ready patients out of their acute-care beds to a dedicated area where they can wait for rides
• Revamping the referral management process – including adoption of an automated system enabling faster, more standardized transitions to behavioral health, rehab, skilled nursing, and other PAC facilities and services
• Boosting acceptance rates – by establishing a curated network of vetted facilities and services, with the data and insights to hold them accountable 

Thinking holistically about PAC transfers

For a growing number of health systems, putting these best practices into action involves adopting a technology platform that removes paperwork and manual tasks from the process, while facilitating patient transfers to a curated set of facilities. 

The technology works best when the vendor partners with the health system to provide best practices that include identifying, engaging, securing, educating, and monitoring high-performing PAC providers to ensure they will efficiently accept even the most challenging cases. Additionally, the partnership should include the ongoing measurement and continuous improvement analysis of the post-acute placement processes that improve PAC transitions and patient throughput bottlenecks. 

Supported by the right technology, all these elements work in tandem to accelerate PAC transitions and ensure the placement of patients with the best PAC facilities and services to meet their needs.

Photo: Tajuddin Molla, Getty Images

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.