Essential components for implementing care coordination and discharge procedures

Abstract

Children’s Mercy Hospital (CMH), a 390-bed free-standing paediatric hospital in Kansas City, Missouri, implemented a formalised patient progression programme in 2022 to enhance patient throughput from pre-arrival to discharge. Utilising Lean process improvement methodologies, CMH identified 88 projects aimed at improving patient progression. In May 2023, CMH opened a patient progression hub, centralising key teams and integrating advanced technology to monitor and manage patient flow. A significant emphasis was placed on discharge and care coordination, with the mission of ensuring safe and timely discharges. Important initiatives included hiring a discharge expediter (DE) to address discharge barriers and implementing projected discharge date (PDD) and clinical readiness date (CRD) to improve discharge transparency and preparation. The patient progression hub features technology from GE Healthcare, with 16 screens continuously displaying pertinent throughput information such as organisational capacity, emergency department (ED) capacity, planned and confirmed discharges, and patients needing transfer from the intensive care unit (ICU) to the medical/surgical units. This real-time data sharing has been crucial in coordinating care and expediting discharges to address system bottlenecks. Additionally, CMH introduced ‘lightning rounds’, which are quick multidisciplinary huddles to review discharge needs. Afternoon rounds were implemented to facilitate continuous communication between charge nurses and care managers. These efforts, supported by innovative technology, have led to substantial improvements in patient outcomes. Timely, well-coordinated discharges have reduced hospital stay durations, minimised readmission rates and enhanced overall patient satisfaction. The initiatives have also resulted in improved capacity management, allowing CMH to better serve its patient population and ensure high-quality, patient-centred care.