As a specialty hospital providing cardiovascular and pulmonary services, Deborah Heart and Lung Center treats some of the highest acuity patients in New Jersey. Although the organization has typically received high patient satisfaction scores, last year a team of clinical and administrative leaders came together to improve the discharge process by making it more patient-centric and ensuring that patients aren’t unnecessarily detained in various areas throughout the center.
Richard Temple, vice president and chief information officer, and Lynn McGrath, M.D., chief medical officer and vice president of medical affairs, spearheaded an initiative to track and analyze the timeliness of Deborah’s patient discharge process. One goal was to increase the number of patients discharged by 10 a.m. each day. It is a win for the patients in terms of satisfaction and frees up beds for patients who are waiting, Temple says.
To study the issue, the team created customized dashboards using the business and clinical analytics (BCA) solution offered by their EHR (electronic health record) vendor Meditech. “I see problems in terms of how we can track them using data to measure improvement,” Temple says. “I realized we could use this BCA tool to push the information out to the right people at the right time. It provided visibility and transparency, and we could break things out by doctor and by unit.”
Before they created the dashboards, Temple had used Excel spreadsheets to track issues around discharge and make presentations at monthly meetings. “I would present numbers based on data people gave me. It was manual and a lot of work,” he says. “Also, if we had a problem in week 1, and here we are in week 4, the damage is already done. Having a real-time window allows you to adjust as things are happening if something is going off the rails.”
Using the new dashboard, Deborah’s leaders could drill down into individual discharges to see what happened. The data could be broken down by the hour, discharging physician, inpatient service, and day of the week, with the ability to drill down to patient detail. The team also tracked discharges that occurred before 11 a.m., to determine if they had missed their goal by a significant amount of time or by mere minutes.
With access to so much data, the team was now able to identify reasons when they missed the 10 a.m. goal. For instance, lack of good transportation options was one challenge identified. “As we looked at individual cases where we missed, improving transportation came to light as one issue,” Temple says. “We worked to improve communication with the family the day before to make sure someone is there to pick them up in the morning. Being able to look at the data by unit and by doctor, and being able to classify reasons for missing the goal gave us a lot of power in terms of zeroing in.”
Using the high-level insight provided by this dashboard, Deborah achieved a tenfold increase in the number of patient discharges before 10 a.m. in less than four months. Staff can home in on particular days of the week in which they fell short of their goals, and use the data to attempt to determine why. They found that their discharges stalled on weekends, when they were short-staffed, and that this backlog often carried over into Mondays as well.
Temple says having the right people in the group and conducting meetings the right way is a huge part of the success. But the timely data is essential. “There is nothing like being able to get a data feed out of your EHR data repository and graph, track and trend it. The Meditech BCA tool is powerful and makes it easy to get information to the people who need to see it.”
Deborah is now applying the same framework to other areas of improvement, such as how long patients are intubated in the intensive care unit. The hospital has set up processes so that information is documented in the EHR and then clinicians can pull those data points into dashboard format.