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The Discharge Planning Dilemma

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

I read with interest – and a bit of sad amuse’ – the post of March 26, 2008 by Robert Wachter MD, entitled “Average Time of Discharge: Why a Hospital is Not a Hilton”; and felt compelled to respond affirmatively to his comments … and more!

Link: http://www.thehealthcareblog.com/the_health_care_blog/2008/03/average-time-of.html

As you may know from prior posts, speaking engagements and books, I am a big Bob Wachter fan [although not necessarily the hospitalist movement] referencing him from our material on www.MedicalBusinessAdvisors.com and www.HealthDictionarySeries.com and periodicals like www.HealthCareFinancials.com where I serve as Editor-in-Chief.  

Moreover, his interests seem to be favoring a more process-driven and quality improvement zeitgeist that’s in the long-term interest of all of us.  

Hospital Discharge Planning

So, what he says about the sad state of hospital discharge planning is not only true in my experience, but nothing new for the industry and hence the cause of my dismay. Unfortunately, it seems that sans some disruptive influence that overcomes inertia; little seems to change in the healthcare industry status quo.

Hopefully, Bob’s notoriety will help change the discharge practice situation he highlights; while personal industry infamy serves to reinforce similar bottleneck situations that not only impact the bottom line – but patient safety – as well.

Other Bottleneck Issues

After all, these issues have plagued hospitals for decades now, and are often accepted as de rigor. However they should not be; for example: 

1. The July starting point problem of new hospital interns and residents.

2. End-of-shift nurse “reporting” and evening hospital (mis) communications.

3. Weekend or “after hour” admissions and departmental scheduling.

4. Similarly named patient and drug mix-ups.

5. Wrong site surgery; lost or stolen infants, etc

Yes, some issues are being address with powerful information technology systems. But, do we really need RFID tags to ensure proper side surgery, or bar codes bracelets for newborns?

A Common Sense Approach

As for me, I helped deliver my own daughter and immediately splashed a (far-too-large) swatch of gentian-violet on her left heel as an identifier; cheap, effective and simple.

And, these other issues might be alleviated with some managerial common sense; along with a dose of mindset change, as well.

How? Well, for starters, how abut staggering employee schedules; providing rolling medical student admissions; placing name tag warnings on patient room doors and extremities [HIPPA be darned] and/or implement the timely outsourcing of laboratory/pathology and other off-hour hospital services?

Assessment

And yep, even my infamous gentian-violet episode is still discussed years later as -um- “insightful.”  Candor, intelligence and goodwill to all!

Conclusion

Your thoughts and comments are appreciated?

More info: http://www.springerpub.com/prod.aspx?prod_id=23759

Institutional: www.HealthcareFinancials.com

Terms: www.HealthDictionarySeries.com

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA – Editor and Publisher-in-Chief – is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com or Bio: http://www.stpub.com/pubs/authors/MARCINKO.htm

Filed under: Op-Editorials | Tagged: Op-Eds |