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We sought to develop a quality improvement method for workflow and resource optimization that is easy to implement, engages multidisciplinary staff, and can be taught and applied across improvement initiatives. Very busy staff, often lacking baseline knowledge of quality improvement methods, needed an easily applicable method to evaluate and implement change with the goal of streamlining workflows. We applied this method to a discrete problem in our inpatient hospital. To test this process, we chose a project that sought to reduce delays in inpatient hospital discharge due to delayed discharge teaching for patients receiving autologous stem cell transplant. This intervention assessed the impact on discharge time when teaching was moved from discharge day to a scheduled appointment 2-3 days prior to discharge. A project team including multi-disciplinary leaders and stakeholders defined problematic elements of the workflow. A process mapping exercise identified problem areas in the current state. Success metrics were defined that reflected the goals of the project. Staff, patients, and caregivers were informed of changes using printed educational materials, project team attendance at nursing meetings, and phone calls. Process mapping was completed for the new workflow (Fig 1). Stakeholders provided feedback on a continuous basis. The project team evaluated the streamlined workflows and educational materials using a pilot approach where the new operating system was implemented in one small part of the organization to start (a single inpatient unit). The pilot received focused attention and resources from the project team to test, refine, and perfect operations. After the new process was running smoothly on the pilot unit, it was then scaled to three additional inpatient units. Using this approach allowed the project team to gain buy-in from frontline staff and generate momentum that resulted in successful change on a small scale before rolling the process out to other units of the inpatient hospital. Control measures are underway to monitor the process and collect and measure outcomes against established metrics. Using this method led to iterative process improvement by implementing discrete changes to a workflow that impacts clinicians, staff, patients, and caregivers. By involving various stakeholders in the process and creating a framework by which changes to a workflow could be evaluated and disseminated, we measured a significant reduction in discharge delays for patients. This method of implementing iterative quality improvement for discrete segments of processes could be more generally utilized in the setting of a large academic medical center. We plan to apply this process to other opportunity areas in our program. [ABSTRACT FROM AUTHOR]

With rapidly increasing demand at academic medical centers, inpatient resource allocation is a critical focus. Patients receiving autologous stem cell transplant (ASCT) often face complicated discharges, requiring lengthy day of discharge teaching sessions from nurses and dietitians that may cause delays in discharge time. We queried if streamlining the complex discharge process by scheduling teaching appointments in advance would reduce unnecessary delays in discharge. An interdisciplinary committee reviewed existing workflows with relevant stakeholders. Process improvement methodologies, including value-stream mapping, were utilized to reduce variation and delays. New teaching workflows ("discharge pilot") were implemented using a model line approach to iteratively test operations on 1 inpatient pod and were later rolled out on 4 (of 10) pods. After IRB review, patients were allocated to receive the discharge pilot based upon admission to one of these pods. Discharge time was compiled to assess impact. Typically, discharge teaching was completed on the day of discharge as clinicians waited for caregivers to arrive, contributing to delays; teaching took 2 hours. Information given in teach sessions varied greatly between clinicians. Beyond poor utilization of staff, patients and caregivers reported they could not retain critical information as they were prepared for discharge. Teach content delivery was standardized using templated guidelines for home and medication preparation. A provider checklist (Fig 1) was created specifying when to complete discharge readiness tasks. Specialized posters were hung in patient rooms for provider documentation and to engage patients and caregivers on their care journey (Fig 2). Nurses distributed caregiver requirements prior to the teaching appointment and caregivers were notified of required attendance. Teaching appointments were scheduled 2-3 days prior to discharge. Between Jan. – Sep. 2019, 58.8% of patients receiving pilot (advance) discharge teachings (n = 68) discharged before 2pm (range 10:27a – 7:01p). During this same time, only 39.7% of patients receiving no discharge intervention (n = 68) discharged before 2pm (range 11:29a – 11:30p) (p = 0.0257) (Fig 3). Scheduling discharge teaching for patients and their caregivers in advance increased discharges from the hospital before 2pm, significant for operational improvement. This optimized staff resource utilization and allowed for more efficient bed turnover. Other factors like central line removal and transfusion timing should be examined. We are now examining satisfaction and anxiety during discharge when advance teaching is performed. Further research should assess precaution adherence for this intervention. [ABSTRACT FROM AUTHOR]