How Boston Medical Center uses automation for early discharge planning

Early discharge planning is key in reducing unnecessary length of stay, expanding bed capacity and realizing cost savings.

But many organizations are falling short even though they have spent so much time running performance improvement projects and customizing their EHR.

During a March webinar hosted by Becker's Hospital Review and sponsored by Qventus, Chris Manasseh, MD, associate chief medical officer of inpatient operations at Boston Medical Center, and Jason Cohen, MD, senior director for clinical solutions at Qventus, discussed five strategies proven to make early discharge planning successful.

At the heart of those strategies lies the idea of improving multidisciplinary rounds. MDRs are critical for care teams to align on discharge goals and define an early discharge plan, but the typical MDR is ineffective: Information is scattered and it's hard for teams to get what they need to plan until the patient is nearly ready to be discharged. "It becomes a scramble to line up post-discharge care but by then it's too late — the patient ends up staying past their clinically ready time and accruing excess days," Dr. Cohen said.

Five strategies to overhaul ineffective MDRs and optimize discharge planning:

1. Make multidisciplinary rounds a strategic priority. This entails building a coalition of champions — with representation from nursing and case management leadership, hospitalists and sub-specialists — to propel a culture around high-performing MDRs. It also involves conveying the importance of MDRs to improving outcomes for patients, care teams and the health system, as well as defining and executing a standard structure that covers common processes, technology tools and key performance indicators for participation and quality. "MDRs are the core foundation that you build and drive your operational efficiency around," Dr. Cohen said.

2. Convene the right team in the right roles. The core makeup of an MDR team comprises a nursing lead, a bedside nurse, a case manager, a provider and ancillary services professionals, such as physical therapists and pharmacists. Because patients are spread across different units, Dr. Manasseh said, "it's paramount that teams are given clear guidance on where to go and when to go for in-person board rounds."

3. Focus the conversation on the discharge plan. Essential to an effective discharge planning conversation are aligning on the estimated date of discharge (EDD), aligning on the discharge disposition and post-acute logistics and addressing potential barriers to discharge. To facilitate this process, BMC provided its care teams with a standardized script of how to discuss patients' clinical information in a structured, efficient way.

4. Use technology to make MDRs and follow-up easier. Technology can be a powerful tool in redesigning MDRs to "hardwire" early discharge planning processes into hospital workflows. By embedding AI and machine learning models that auto populate patients' real-time clinical progress data into their care plans, suggest EDDs and dispositions, identify potential barriers, automate care coordination activities and integrate with EHRs to avoid double documentation, automation platforms such as Qventus can optimize this strategy. Incorporating such technologies can reduce the manual burden of discharge planning, improve planning quality and result in up to 30-50 percent fewer excess days. Health systems can expect up to a tenfold return on investment from this technology.

5. Leverage data to drive and sustain best practices. To sustain these best practices, it is important that organizations measure MDR quality by tracking when EDD, disposition and barriers are discussed during a patient's stay; provide tangible feedback to help care teams home in on areas where they may need to improve; recognize and reward good performance and use data to show how MDRs are benefiting patient care and improving operational efficiency.

By applying these best practices, BMC now has a system for early discharge planning at scale. Over 53% of BMC patients have early discharge plans, and those patients average 0.8 days fewer excess days, compared to those patients without early discharge plans. What’s more, these efficiency improvements have created more than 13 beds of new capacity — without adding new resources — and have saved over 25,400 FTE hours.

Given current staffing challenges, this strategy is more important than ever. “When we started this work in 2020, we really saw this as an urgent priority and committed to doing it rather than delaying it,” said Dr. Manasseh. “Without this system in place, we likely would have experienced even more significant capacity challenges, and it would have been even harder on our teams. This system reduces workload intensity, mitigates process variability, and optimizes our existing staff and resources. We actually feel much stronger today because of this.”

To learn how you can implement these MDR best practices, view the E-book here. You can also watch the webinar recording here

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