Hospital Delays
- Delays in discharge from the ICU
- Lack of available beds on regular ward
- Caused by unnecessarily prolonged hospital stays
- Delays in patient transfers and discharge
The hospital experiences delays in discharge from the ICU. The research shows that the main cause of delays in transfer from the ICU is the lack of an “appropriate bed on the regular ward” (Edenharter, 2019). This is due to prolonged stays caused by patient transfer and discharge delays that can also affect patient care (Evans, 2020). Thus, by improving the hospital transfer and hospital discharge procedure, the issue can be meliorated.
Improving the Situation
- Introducing a comprehensive discharge unit
- Will accommodate patients ready to be discharged
- 247, armchairs, beds, shower facilities
- Increased customer satisfaction, reduced length of stay
A comprehensive discharge unit will accommodate patients ready to be discharged or transferred to other facilities and awaiting transportation. The unit will function 247 and will be equipped with necessary staff (at least one RN and one NA per shift), armchairs, beds for patients (6-10 beds), and shower facilities. This will improve patient flow and free up beds in regular units. Moreover, research indicates that a discharge unit leads to an increase in customer satisfaction, reduces length of stay and discharge errors (Curle & Maduro, 2020). Therefore, the unit will have a significant positive influence on the overall workflow.
Stakeholders
- Staff – integrating the unit into workflow
- Patients – transferred to the discharge unit
- Family members, visiting or taking patients home
- Other patients, administration and potential funders
The medical staff will have to integrate the unit into their workflow, whereas the managerial staff will deal with developing shift schedules, finding and assigning personnel. The change will directly affect patients transferred to the unit and the family members who might be visiting or taking them home. However, those who will occupy the freed-up beds will also be among the stakeholders. More broadly, the change will affect the hospital as a whole, first and foremost due to financial costs. If external funding is secured, the funders will be among the stakeholders as well.
Implementation
- Change leader – drive change, procure funding
- Change manager – oversee processes, responsible for communication
- Facilities manager – ensure adequate space, facilities
- Facilities management personnel – equip the space
- Hospital administrator – allocate the necessary personnel
The change management team will include a change leader, a change manager, a facilities manager, facilities management personnel (up to 5 people), and a hospital administrator. Change leader will drive the change, formulate the vision, and procure funding, if necessary. Change manager will oversee all the processes, make sure the initiative is carried out within the allocated budget and deadlines, be responsible for effective communication. Facilities manager will ensure adequate space and facilities for the unit. Facilities management personnel will assist with equipping the discharge unit. Hospital administrator will allocate the necessary personnel to work at the unit.
Communication
- Change manager is responsible for the communication
- Communication targets staff and patients
- Staff informed via email, flyers, handouts, lectures
- Patients informed by administration and nurses
The change will need to be effectively communicated to the hospital staff and patients. As mentioned earlier, the change manager will be responsible for the communication. The process of communication should be active at all stages of the implementation of the change. The staff will be informed and duly educated via email, flyers, printed handouts, and brief lectures. The patient will be informed by the administrative personnel and their primary nurses.
Risks
- Lack of communication – danger for the project
- Prioritized communication throughout the change implementation
- Risk – insufficient funding and high costs
- Mitigating measure – volunteer recruitment, use of hospital’s spaces
The anticipated risks include lack of communication and insufficient funding, or exorbitantly high costs. According to the research, “changes have a greater chance of succeeding if employees consider them to be well thought out and respect the managers responsible for the changes” (Nilsen et al., 2020). To mitigate this risk, communication should be prioritized from the initial stages of the change implementation. Insufficient funding can be mitigated by recruiting volunteers and using already available spaces at the hospital.
References
Curle, B. W., & Maduro, R. (2020). Discharge unit efficiency: A dedicated discharge unit decreases length of stay and improves ED treat and admit times. American Nurse Journal, 15(9), 85-89.
Edenharter G., Gartner D., Heim M., Martin J., Pfeiffer U., Vogt F., Braun K. & Pförringer D. (2019). Delay of transfer from the intensive care unit: A prospective observational analysis on economic effects of delayed in-house transfer. Eur J Med Res 24(30). Web.
Evans, L., Evans, N., & Miklosik, A. (2020). Consequences of ineffective information and knowledge management (IKM) in hospitals: Junior doctors’ perspectives. Knowledge Management Research & Practice, 1-12. Web.
Nilsen P., Seing I., Ericsson C., Birken S. A. & Schildmeijer K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. BMC Health Serv Res, 20(147). Web.