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Reducing Length of Stay by Enhancing Patient’s Discharge

Prolonged hospital stay following surgery can increase healthcare cost and decrease patient satisfaction. On the cardio thoracic surgery service at Mayo Clinic the expected length of stay following open heart surgery is 5-7 days. Multiple factors can influence the length of stay following surgery such as post surgical complications, availability of necessary services at discharge, and patient understanding of how to care for themselves following surgery. A gap in care was identified related to patient education following open heart surgery. This included a lack of patient education curriculum; patient’s receiving discharge education immediately prior to hospital discharge, and poor communication among the patient and multidisciplinary staff regarding the patient’s progression along their recovery and readiness for discharge.

Methods:

A discharge curriculum was created using the Plan-Do-Study-Act quality improvement methodology. The discharge curriculum was a patient folder that used 4 components: Caring for Yourself After Heart Surgery, Common Medications After Heart Surgery, Discharge Goals After Heart Surgery, and a Media Guide. A discharge pathway was created which started on the day that the patient was admitted to the telemetry unit at which time the patient was given the folder and the discharge education was started. The pathways was designed to be centered around the patient so that they are able to be engaged with their recovery and can understand what are the goals that they need to meet to be able to discharge from the hospital. The discharge pathway also included creation of daily discharge rounds between the charge nurse, the case manager, and the cardio thoracic surgery provider. Voice of the Customer was the quality improvement Methodology that was used for the discharge pathway. Data was collected in a 6 month PRE intervention period and then again in a 6 month POST intervention period.

Results:

The length of stay following surgery showed a reduction of 0.8 hospital days. Additionally, the data was looked at categorically. Patients staying 5 days or less in the PRE group was 18% and 43% in the POST group. Length of stay following surgery in the 6-7 day range was 46% in the PRE group and 35% in the POST group, and length of stay following surgery greater than 7 days was 36% in the PRE group and 22% in the POST group (see table below). A counterbalance measure was used which was that patient satisfaction with their hospital experience would remain high. The Avatar patient satisfaction survey data showed continued high performance with patients overall satisfaction with their hospitalization of 85.71% in the PRE group to 91.41% in the POST group.

Conclusions:

Starting discharge planning early and engaging the patient in the discharge education process as well as creating a forum for multidisciplinary review of patient’s discharge planning needs can reduce the length of stay following open heart surgery.

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