Decreasing Discharge Time in a Hospital by Application of HMIS

Transcription

1 Decreasing Discharge Time in a Hospita by Appication of HMIS Dr. Pranav Thaker* and Ravinder Singh** Key words: Heath Information Management System (HIMS), Discharge Time, Discharge Summary and Discharge Card Abstract Weak HIMS (Heath Information Management System) software hampers the productivity of a hospita bady. The huge amount of information generated in hospitas in of no use if not captured and anayzed propery to increase the productivity and patient satisfaction. Effective strategies must be in pace for impementing proper HIMS so that there is better coordination between different departments and it decreases the Discharge time as it is the fina step in the hospita experience and is ikey to be we remembered by the patient. Sow or unpredictabe discharge transates into a reduction in effective bed capacity and admission process deays. The case study presents herewith modification and impementation of certain changes in the existing software and integration of a the medica and operationa modues of the software ike Pathoogy, Radioogy, Patient Care and Biing and aso certain changes made in the Discharge process. Effectiveness of the modified software has been tested on the work fow by comparing outcomes between the pre-impementation contro group and the post-impementation experimenta group. The impementation of the software resuted in drastic decrease in discharge time and resuted in increased patient satisfaction and decrease in the number of payment defauters. Introduction Nirma Hospita Private Limited ocated at Surat (Gujarat) is a tertiary care muti speciaity hospita with a catchment area of entire South Gujarat and neighboring districts of Maharashtra. The hospita has an exceent reputation among the common pubic and is a referra centre for the entire South Gujarat. Though the patients were satisfied with the cinica services, some of the common compaints mentioned by patients in their feedback reate to discharge process and reated aspects. Presentation The discharge process is a critica botteneck for efficient patient fow. Sow or unpredictabe discharge transates into a reduction in effective bed capacity and admission process deays. In fact, the discharge process and scheduing in-patient surgery rank as the two biggest factors impacting wait times for in-patient beds. Nobody wiingy gets admitted in a hospita. To a person getting admitted, nothing is more scary than the sight and thought of Operation *COO & Medica Director and **AGM Operations & Business Deveopment, Nirma Hospita Private Limited, Surat. 14 Nirma Hospita

2 Theatre (OT) and wards fied with sick patients. To him, the moment he is certified fit for discharge, is the happiest and reieving moment. Ony he can expain the urge to get back home and be with his famiy, but what comes in the way is the time taken to discharge the patient. Feedback anaysis shows that major probems reated to discharge issues as faced by patients in the Nirma Hospita are found to be as foows: The discharge process takes three to four hours even after the doctor had advised discharge. The patients are not informed about the bi amount on a reguar basis and at the time of discharge it is difficut for the patients to arrange for cash when the bi amount is high. The preparation of Discharge Summary takes too ong and there are too many mistakes in the discharge summary. Some of the probems being faced by the staff were as foows As the Discharge Process was taking too ong, it was getting difficut for aotting rooms to new patients waiting for admission which often ed to dissatisfaction and resentment among the reatives. Patients get diverted to other hospitas due to non avaiabiity of beds The Medica Officers and the consutants compained that the Laboratory reports were not coming on time which deayed the starting of treatment of the patients. The Laboratory staff on their part said that though the reports are ready it is difficut to type the reports due to excess work oad and shortage of staff. As Interim bis were not being prepared on a reguar basis, the cases of defaut of payment were very high which was making it difficut for the management. As the Biing cerk has to make a the entries of the procedures/tests done at the time of making the fina bi, it makes the job very engthy and cumbersome. The Discharge process was not proper and it needed to be rectified. As Nirma Hospita is an Academic Institute, running many Feowship and DNB (Pediatric) course, it was often found that the Feows/Students did not get the required data/information for their Thesis/Research. Thus the need of the hour was: Ø Study the entire Discharge procedure and bring down the Discharge time. Ø Make sure Diagnostic reports are avaiabe with the Cinica team on time so that the treatment of the patient can be started as soon as possibe. Ø Minimize the cases of defaut of payment. Ø Ensure that the beds are avaiabe and minimize the instances of patients being diverted to other hospitas for non avaiabiity of beds. The major probem with the software being used was that a the modues were working as standaone individuas. It was decided to review the HMIS Decreasing Discharge Time in a Hospita by Appication of HMIS 15

3 system of the hospita and work on the feasibiity of integrating a the major modues of the software which coud resut in improving the workfow and efficiency of the various services of each department. It was further decided to: Seect a sampe size of 50 patients to assess the prevaent Discharge process. Study the roe of a the payers invoved in the Discharge Process. Study the communication system between the payers. Identify the bottenecks in the Discharge Process. Integrated the Biing and the Cinica modues of the software. Pioted the software among 50 randomy seected the patients admitted in the hospita. Tested the effectiveness of the initiative by comparing the Discharge Time and other indicators before and after impementation of the new initiative. It was decided to monitor the entire Discharge procedure to begin with so that we coud identify the areas where we were going wrong and corrective action coud be taken. The team began with a step to visuay understand how the Discharge process was currenty working. When severa nurses and other staff invoved in the Discharge Process were asked to narrate the steps foowed during the discharge process, they initiay coud not reach consensus, since they each foowed their own methods for discharging the patient. This ack of standard operating procedures had ed to widespread process variation. After streamining the process, The Discharge process was divided into the foowing six parts:time of advising Discharge Time of preparation of Discharge Card Time of sending fie to Biing Department Time when fina bi is ready Time when Fina bi is cear Time of Counseing with Medica Officer Time when Patient eaves from the room 1 Nirma Hospita

4 It was then decided to study the entire discharge procedure of randomy seected patients to arrive at the exact time taken for discharge and to find out the time taken for each process. Fifty patients were seected for the study and the breakup of the time taken for each step in the Discharge Procedure is as mentioned beow: On breaking up the entire Discharge process the foowing facts came forward:s.no. ACTIVITY AVERAGE TIME TAKEN 1 for preparing Discharge Card 3 2 in sending the fie to the biing department 15 3 in preparing the bi 41 4 for cearance of bi 13 5 for counseing by the patient to vacate the room 14 It came to the knowedge that the two activities that were taking the most of the time were Preparation of Discharge Card and Preparation of fina bi. The management decided to take the foowing steps to streamine the discharge process: 1) It was decided to update the inpatient fies on a daiy basis and the provision for the same was provided at each Patient care department. 2) A new post of Foor coordinators was created and the primary responsibiity of the coordinators was to update the inpatient fies and enter any procedure that takes pace in the software. 3) The Biing modue was aso integrated with the Cinica modue and hence any entries made in the cinica modue, the entries were refected in the Biing modue as we. 4) A the detais were being entered onine and any patient ikey to be discharged next day, the Medica officer on duty was asked to update the fie and keep it ready for the next day. 5) The Consutants were requested to take the round of the ikey discharge patients first so that their discharge formaities coud be started. ) The aboratory modue was aso connected with the Cinica modue and the Impementation and Their Resuts The process was impemented for a period of one month and after that Fifty patients were again seected on a randomy basis and the resuts were monitored after the same. On breaking up the entire Discharge process the foowing facts came forward: Decreasing Discharge Time in a Hospita by Appication of HMIS 1

5 S.No. ACTIVITY AVERAGE TIME TAKEN 1 for preparing Discharge Card 2 in sending the fie to the biing department 3 in preparing the bi 4 for cearance of bi 5 for counseing by the patient to vacate the room Discussion A engthy, inefficient process for discharging in-patients is a common concern of hospitas. It not ony causes frustration for patients and famiy members, but aso has an impact on hospitas abiity to cut waiting ists and deiver heathcare effectivey and efficienty. As the fina step in the hospita experience, the discharge process is ikey to be we remembered by the patient. Even if everything ese went satisfactoriy, a sow, frustrating discharge process can resut in ow patient satisfaction. The modified integrated software on HMIS as evoved and experimented in the way described above has resuted into manifod benefits as shown in the foowing comparison: A graphica representation foows the tabuar comparison. Comparison S.No. ACTIVITY EARLIER AFTER IMPROVEMENT 1 for preparing Discharge Card 3 2 in sending the fie to the biing department 15 3 in preparing the bi 41 4 for cearance of bi 13 5 for counseing On breaking up the entire Discharge process after impementing the changes, the foowing facts came forward. It was found that the Discharge time came down significanty. Biing modue and hence whenever the resut of any test was entered in the system, the Doctor coud view the same in his department without waiting for hardcopy of the report and the charges of the tests were refected in the bi of the patient as we. As a the entries were being done onine, it was easy for the Biing department to generate Interim Bis and inform the patients about their 18 Nirma Hospita

6 Series 1 25 Series for Prep. Disch card in sending the fie to the biing dept. 14 in prep the bi for cearance of bi for counseing by the pt. to vacate the room biing status ti date. The incidents of defaut of payment by the patients aso came down drasticay as the Biing staff was abe to keep a daiy track of the Indoor bi of a patients and were abe to ask the reatives to cear the outstanding bi from time to time. The reports of patients can be viewed onine which heps the Cinica team to start the treatment without wasting precious time. Concusion Smoothening of discharge process resuted in increased satisfaction among the patients which in turn resuted in repeat visits of the patients. It was found on anayzing the Feedback form of patients that 22% of the patients wrote that they woud recommend Nirma Hospita to their famiy members and friends for their heath care needs. Improvement in the services resuted in increase in referra cases from the medica fraternity. The occupancy of the hospita which was around 4550% rose to 5-0%. Improvement in the services aso motivated other Visiting Consutants to admit their patients in Nirma Hospita. Decreasing Discharge Time in a Hospita by Appication of HMIS 19