A comparative time motion study of all types of patient discharges in a hospital (original) (raw)
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International Journal of Research Foundation of Hospital and Healthcare Administration
Background: The discharge of a patient is a time-consuming process comprising of clinical, financial, legal, and administrative and recordkeeping aspects that require proper execution. The discharge process is considered as an important quality indicator of the healthcare services of a hospital. Every hospital has its own discharge policy. Objectives: To study the steps in the discharge process in a tertiary care teaching hospital and identify the causes of delays in in-patient discharges in major clinical wards. Materials and methods: The study was conducted in four major clinical wards of AIIMS, Bhubaneswar. The discharge process was recorded using a structured format that was distributed in all the wards. The patient satisfaction and impression regarding the discharged process were recorded using a questionnaire. Results: The various steps identified in the discharge process were discharge summary writing, billing clearance, and patient leaving the hospital. Billing clearance contributed the maximum time from the total time taken for discharge followed by the discharge summary writing. Most of the patients rated their discharge process experience as above average and opined that the discharge process in the hospital was well organized. Conclusion: Discharging patients on time is a challenging task. With adequate manpower and proper patient counseling, the time taken for the process can be reduced. Improving the time taken for a discharge can improve the patient's satisfaction as well as effective bed management for the hospital.
A Study to Assess the Factors Contributing to Delay in Discharge Process in a Teaching Hospital
International Journal of Research Foundation of Hospital and Healthcare Administration, 2019
Background: Delay in obtaining discharge is often a reason for dissatisfaction for patients, even for those who may have had a comparatively uneventful stay in the hospital. Aim: To study the factors contributing to delay in discharge process in a teaching hospital. Materials and methods: A time motion study was conducted in a teaching hospital wherein the time taken for discharge was measured for 69 patients. The outcome variable in the study was the time needed for the discharge process in total as well as for each individual step. Mean time at each step was identified and compared between groups using t test and analysis of variance (ANOVA). Results: The mean time for discharge process was 5 hours 41 minutes. The mean time between advice of discharge and physically leaving the ward varied from 6.62 hours in urology to 3.01 hours in ear, nose and throat (ENT). Only 13 patients (18.8%) were discharged within the National Accreditation Board for Hospitals and Healthcare Providers (NABH) prescribed time limit of 180 minutes. The maximum delay occurred during time taken for discharge summary completion. Conclusion: Very few patients were discharged within the prescribed time limit, with considerable delay in the time taken for discharge summary completion.
Hospital patient discharge process: an evaluation
European Journal of Hospital Pharmacy, 2016
Objectives Medication discrepancies for patients after discharge from hospital are well documented. They have been shown to cause unnecessary harm to patients and can result in hospital readmission. To improve patient discharge, the current process of discharging patients from hospital (the discharge process) needs evaluating to determine where and why medication issues occur. This study aimed to identify and evaluate the discharge process used in a range of acute National Health Service hospitals across the North West of England. Methods This qualitative study involved semi-structured telephone interviews with 13 chief pharmacists or an appropriately nominated member of the hospital pharmacy team. Thematic analysis of the transcribed interview data was performed. Data analysis revealed eight main themes which all impacted on the discharge process. Results The study was successful in identifying the discharge process across the range of hospitals as well as key issues and examples of good practice. The hospitals involved in the study were found to have similar discharge processes with issues common to all. One significant finding was a lack of patient involvement in the discharge process. Conclusions To improve the patient discharge process, innovative solutions are required to overcome the current issues. In future work, the study findings will be used to develop a new model of care for patient discharge from hospital.
2020
The present study was designed to evaluate a large private hospital and study the incidences of delay in discharge of patient, corrective action/steps which can be taken to resolve the delay in discharge and study the consequences resulting from delay of discharge, post medical advice. Seventy two discharges planned were studied by on field study and suggestions were sought on how hospital process can be improved. The results indicate that 16% of discharges get cancelled and the occurrence of delay in discharge are due to lack of coordination, communication amongst the staff members and lack of shared understanding about the problem. It was also observed that process design is a critical factor and the missing gaps in design result in locating a systemic delay in discharge and thus finding solutions to problems. These findings will subsequently help the hospitals to streamline discharge processes but also provide a methodology to other sectors to resolve issue involved in similar se...
International Journal of Contemporary Pediatrics
Delay in discharge of the patient reduces bed availability in any healthcare organization. In spite of advancement in medical systems and hospital management, delay in patient discharges still exist. Hence, there was a need to evaluate factors contributing to the delay in an exclusive paediatric hospital. A study of patient discharges from a private and a general ward was undertaken at a tertiary care paediatric hospital in Mumbai, between September-October 2021. A total of 60 discharges, 30 from each ward were analysed. The time from discharge order given by the consultant to that of the patient leaving the hospital and the reasons for delay were recorded by the investigators. The hospital followed a policy of 180 min for a discharge. The mean duration of discharge in the general ward was 153.18±34.60 min and whereas it was 165.41±62.29 min in the private ward. However, 28% discharges in general ward and 43% discharges in private ward were delayed with a mean of 5.23±10.04 and 20.6...
Evidence Based Health Policy, Management and Economics
Background:The process of the patient discharge from the hospital is one of the most important processes that has been taken into consideration by managers in recent years. An efficient health system can only accomplish its duty to provide the health of the community by providing the right services and this system can be evaluated through its services. Therefore, the necessity of performing this research is to improve the quality of hospital services for patients and increasing patient satisfaction. This study has been aimed to identify the factors affecting the process of patient discharge. Methods: This was a cross-sectional study conducted in a general hospital located in Takestan, Qazvin in 2019. The study population in the qualitative section of the study included those who were aware of the discharge process and had managerial positions in the hospital. The sampling process was continued until achieving data saturation. The required information was gathered through reviewing r...
2019
Patients taking Discharge Against Medical Advice have an increased risk of hospital readmission, morbidity, mortality, which leads to increase in healthcare costs and puts an undue burden on the healthcare system due to an inadequately treated initial condition. Studies on the incidence, predictors and outcomes of DAMA have been limited in Indian settings. Studying the correlates of DAMA can help in interventions with an aim to reduce the rate of DAMA, increase patient satisfaction, and improve the quality of patient care and services provided at the hospital. Materials and Methodology: This study was a retrospective cross-sectional study and was carried out in a 700 bed multi-speciality tertiary care hospital in Kolkata from January 2018 to October 2019. From, 68,010 patients admitted in the hospital during the said period, 2028 patients took DAMA. Data for the study was collated and entered into SPSS-v19 software. Frequencies and percentages were used to report the results of the ...
Review on Different Types of Discharges in a Tertiary Care Health Facility
https://www.ijhsr.org/IJHSR\_Vol.13\_Issue.10\_Oct2023/IJHSR-Abstract17.html, 2023
Discharge planning is a multidisciplinary process of providing care at health process; it involves steps that is goal oriented, identifying the need, assessment, planning, implementation, coordination, and evaluation. It is a bridge between health facility, community health services, NGOs and care providers. These studies can provide us with wider range of problems that can occur during the admission of IPDs. These includes problems like A. what specialty is having highest discharge rate B. is the unplanned discharge is due to certain specific Provider in the speciality C. is the patient is not satisfying with the utility and other services D. Is nursing care not up to standard F. financial issues of the patients
Study of Hospital Discharge Process viz a viz Prescribed NABH Standards
International journal of contemporary medical research, 2018
Introduction: NABH defines discharge as a process by which a patient is shifted out from the hospital with all concerned medical summaries ensuring stability. The discharge process is deemed to have started when the consultant formally approves discharge and ends with the patient leaving the clinical unit. The study aimed to view the discharge process of SKIMS, compare it with NABH criteria AAC 13 and 14 and look for any bottlenecks. Material and Methods: The study was carried out in General medicine and General Surgery wards of inpatient department of SKIMS. It was an observational type of study where in all the patients who got discharged in the said wards from 10am to 4pm daily (Except Sundays) were observed for Discharge process including average time taken and the existing Discharge Process in SKIMS was compared with National board of Hospitals and health care organization (NABH) standards and objective elements. Results: A total of 710 Discharged patients were observed during the study period which includes 417 patients from General surgery department and 293 patients from General medicine side. The results show that the average time taken for discharge process was 240 minutes for those who had a planned discharge and had to pay out of pocket (Self-Payment). It was 255 minutes for those who had been discharged against medical advice (DAMA) while it was 270 minutes for below poverty line (BPL) patients who had to exempt hospital charges. The discharge time for all types of discharges was higher when compared to NABH criteria's. Conclusion: The results clearly indicate that average time taken for all types of discharges in SKIMS is more than prescribed NABH criteria. SKIMS as per the observations is following many objective elements of standards AAC 13 and 14 but discharge process and time needs to be defined and documented. The SKIMS should formulate a policy regarding a discharge process of a hospital wherein steps and time taken should be clearly defined and all measures should be taken in order to adhere to NABH standards.