LEAN Healthcare: Evaluation of the Discharge Process at Mid-Sized Hospital

Introduction/Objectives: A team of 8 osteopathic medical students were tasked with learning and implementing the LEAN process. LEAN is a philosophy of process improvement through creation of standard workflow and minimization of waste. Oklahoma State University Center for Health Systems Innovation in partnership with Oklahoma State University Medical Center tasked the team with identifying inefficiencies embedded within the Discharge Process specifically, patients being discharged from inpatient units. This research discusses the teams findings and recommendations provided to hospital leadership.

Methods: The Medical student team participated in lecture and simulation instruction led by two LEAN trainers to obtain knowledge of the use of LEAN in healthcare settings. The Students involved performed Gemba walk at a local hospital on Medical/Surgical floors specifically observing tasks related to discharging patients, interviewed key players that contribute to the discharge process, obtained perspectives on the current state, known inefficiencies, and recommendations for change. Documentation was obtained for current protocols / standard operating procedures. The team shadowed staff and collected data points for 40 patients including date of discharge, time discharge order was signed, time After Visit Summary was printed and signed, time patient exited unit, and time patient was marked ‘Out of Room’ on EPIC. Information was collected regarding events associated with discharging the patient through observation and communication with staff involved. A flow chart was then created to map out the current state for discharging a patient, identified areas of inefficiencies, notated with ‘Storm Clouds’ were shown on the flow chart. Students then analyzed inefficiencies and potential recommendations evaluating benefit vs. effort, controllable vs non-controllable, and cost vs no cost. At the end of the project, the team presented LEAN Discovery Recommendations to hospital leadership.

Results: The current state of the discharge process was divided into three stages. Stage one begins when the patient is admitted to the hospital and ends the morning of discharge. Stage two takes place from pre-rounds to when the discharge order is placed in Epic. Stage three begins after the discharge order is placed and ends when the Environmental Services Department is notified of patient's departure. During stage one, we observed inconsistent communication between care teams, a lack of standardization, and no defined role for collecting a discharge pharmacy. Stage two showed a lack of standardization amongst physician teams and inconsistent communication of potential patient discharge between hospital leadership and nursing staff. Inefficiencies observed in stage three consisted of discharge orders placed with pending tasks and difficulties securing patient transportation.

Conclusions: The team’s investigation of this topic identified themes of inefficiencies: standardization, defined roles, and communication. With the implementation of LEAN training students produced potential recommendations of cost-effective interventions and “best practice” procedures for key players involved.