Quality officers tackle pandemic throughput with discharge improvement

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Quality teams had to manage the push and pull of maximizing the discharge process to create bed space while ensuring patients went home with everything they needed to prevent them from ending up back in one of those beds.

Allegheny revamped reviews of social determinants risk profiles for patients without COVID-19 before discharge. The health system considered factors at home that could create a higher risk for readmission, such as transportation access and food insecurity. Patients were also connected with nurses two days after discharge instead of the usual seven.

ChristianaCare, a two-hospital system based in Wilmington, Delaware, already had experience with throughput issues related to stroke patients before the pandemic. When it became apparent that their standard admission criteria would result in care delays because of bed capacity, the not-for-profit system looked to the telemedicine system already used for its stroke program.

Certain patients who previously would have been admitted instead went home. ChristianaCare connects them with remote nurses and other caregivers who supervise them via at-home equipment the hospital provides. The health system hasn’t seen bumps in readmissions, post-surgical complications or infections, said Chief Medical Officer Dr. Kert Anzilotti.

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“That was a real quality and safety challenge, because we had to make sure they got their rehab, they got their physical therapy, they were going to do all those steps that they would have done as an inpatient toward the rehab,” Anzilotti said. “We really had no choice during COVID-19 but to do things differently and innovate.”

The discharge period is usually the most risky for patients, because they go from a highly controlled environment to homes or other environments without equivalent oversight. Recognizing this, UPMC’s Burwell got involved.

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