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To study the factors contributing to delay in discharges of inpatients and applying lean intervention to improve the discharge process in a tertiary care teaching hospital in south India

Author: 
Dr. Saba Fatima, Dr. M Rajiv, Dr. Satyanarayana, N. and Dr. Rao, J.N.
Subject Area: 
Health Sciences
Abstract: 

Objective: The objective of the study is to identify the gaps, highlight those areas where delay in discharge of inpatients can be eliminated and recommend accordingly, so that the hospital discharge process can be managed smoothly. Methods: A prospective observational study, with data of patients admitted in medical and surgical departments was conducted in a convenient sample of 280 inpatients and the quick changeover approach, also known as the single-minute exchange of die (SMED), was selected as it aims at increasing productivity by reducing waiting times and unused human talent. The data was collected and analyzed from August 2021 to October 2021 at tertiary care teaching Hospital. Results: The average time taken for 32% of patients discharge is 8-10 hrs, 26 % of patients is 6-8 hrs, 20% of patients is 4-6 hrs, 16% of patients is more than 10 hrs and 6% of patients is 2-4 hrs. Using Ishikawa diagram, the possible causes of delayed discharges are illustrated. Showing Pareto chart, the reasons contributing for delay in discharge process, it highlights the credit, billing and patient factor in delay of discharge. Showing 20% of delay in vacating causes 80 % of delay in bed allotment. After the process diagnosis and data collection, the quick changeover approach is conducted before and after the implementation. Conclusion: The delays were mainly related to processes that could be improved by lean intervention. Orienting the hospital settings with measures to prevent causes and implement changes to decrease the effect of delayed discharge process. Thus, interventions should be developed to reduce overcrowding, for higher availability of hospital beds and to improve patient satisfaction.

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