Table 1 Table of interventions/events during the DBN initiative
From: Increasing and sustaining discharges by noon – a multi-year process improvement project
Phase | Intervention | Subcategory | Description | Date |
|---|---|---|---|---|
Phase 1 | Intervention launched for first teaching teams | Main intervention Infrastructure | Interdisciplinary huddle with nurses, physicians, and case management to proactively plan discharges | 12/01/18 |
Intervention launched for remaining teaching teams on other floors | Main intervention Infrastructure | 01/01/19 | ||
Phase 2 | Discharge Expediters & Case Management added to direct care medical teams | Infrastructure | Team-based care coordination | 07/01/19 |
DBN initiative work group created to include physicians and APP's | Fostering collaboration on care teams | Physicians and APPs reflect on past performance and opportunities to improve early discharges | 05/21/20 | |
Faculty Development Conference for physician and APP groups regarding DBN initiative | Educating house staff and faculty Fostering collaboration on care teams One-time event | Event by DBN initiative Champions to teach physician and APP staff best practices for early discharge | 05/28/20 | |
New Post Graduate Year 1 (PGY-1) residents are inducted into the program | Obstacles to achieving high DBN rates | PGY-1 s require time to acclimate to residency and the DBN initiative | 07/01/20 | |
Large COVID Case Surge | Obstacles to achieving high DBN rates | COVID Infection rates soar in early July, crowding the hospital and ED | 07/01/20 | |
Epic (Electronic Health Records) Rollout | Infrastructure Obstacles to achieving high DBN rates | All providers required time to adapt to new EHR leading to a barrier to early discharge | 07/11/20 | |
Implementation of a discharge checklist for teaching teams | Educating house staff and faculty | Steps to prepare a patient for discharge | 10/27/20—11/17/20 | |
Department administrator sends emails to physicians and APP's recognizing high performers | Direct engagement with practitioners | Feedback for providers regarding early discharge performance only for the highest performing providers | 11/20/20 | |
DBN initiative Noon conference for residents and presentation of Discharge Checklist | Educating house staff and faculty One-time event | Hospitalist teaching house staff the steps to prepare a patient for discharge | 12/09/20 | |
Email to teaching team attending physicians each block reminding them of the DBN Initiative | Educating house staff and faculty Direct engagement with practitioners | Email includes best practices for early discharge | 12/10/20 | |
Projects in Progress Faculty Development conference | Educating house staff and faculty Direct engagement with practitioners | Small meeting with DBN initiative champions and hospitalists to rebuild interest in early discharge | 04/27/21 | |
Medical teams switch from a team-based to unit-based case management staffing model | Staffing Model Infrastructure Obstacles to achieving high DBN rates | Increases the number of case managers with whom providers must interact; prevents in-person interdisciplinary flash rounds | 06/15/21 | |
Phase 3 | New Post Graduate Year 1 (PGY-1) residents are inducted into the program | Obstacles to achieving high DBN rates | PGY-1s require time to acclimate to residency | 07/01/21 |
Large COVID Case Surge | Obstacles to achieving high DBN rates | COVID Infection rates soar in early July, crowding the hospital and ED | 07/01/21 | |
Began sharing DBN data to individual practitioners via performance packets | Educating house staff and faculty Direct engagement with practitioners | All providers receive feedback rather than exclusively top performers | 07/15/21 | |
Implementation of Electronic Secure Chat with Case Management and Nursing | Infrastructure | Substitute for in-person interdisciplinary flash rounds; occurs each morning. Allows practitioners to remotely discuss patient readiness for discharge in a algorithmic manner | 07/15/21 | |
Presentation of DBN initiative to residents | Educating house staff and faculty One-time event | Education for all house staff to promote DBN initiative on teaching teams | 08/18/21 |