It’s 10:00 a.m. on a weekday morning in the obstetrics department of your hospital, and there are 20 discharges that need to be completed. Some patients are awaiting discharge orders, others are waiting for baby photos or birth certificates, and some are waiting for their loved ones to give them a ride home.

At the same time, 10 exhausted patients who have recovered from their early morning inductions and Cesarean sections are being held up on the labor and delivery unit waiting for a room in postpartum. To add to the chaos, the triage unit is backed up because there are no L&D rooms available. 

Does this scenario sound familiar? Are your patient satisfaction scores suffering because of this?

Increasing birth volume and the ever-climbing rate of Cesarean births are stretching the limits of hospital staff and affecting the quality of care given to both mother and baby. In addition, an increase in scheduled procedures has concentrated a large percentage of vaginal births and Cesarean deliveries to weekdays, creating a low census on Mondays and Tuesdays and an overflow situation on Thursdays and Fridays. 

What is a hospital administrator to do in this challenging environment? Take a deep breath—there is a way to ease the situation. By making some process modifications and implementing two basic tools, patient flow can be dramatically improved and additional capacity created to ensure the ultimate patient experience. 

Clear expectations

Let’s start with the patient itinerary—a one-page sheet that lists all of the activities that will occur during the postpartum stay, the expected timeframe for each activity, and pertinent information about the hospital, such as department phone numbers and contacts. 

Each itinerary is customized for the patient and is based on the delivery time and type. The itinerary provides clear expectations for the patients and allows them to take an active role in their postpartum stay. For example, a patient might tell a nurse, “I was supposed to have my baby photos taken at 11:00, and the photographer hasn’t been here yet.” That statement allows the nurse to proactively address the issue prior to discharge. 

The patient itinerary was recently implemented at Woman’s Hospital in Baton Rouge, La. and provided significant benefits, including increased patient satisfaction, reduced length of stay, and decreased workload for the nursing staff. Nurses report they are able to spend more time focusing on patient care and less time answering questions. 

Discharge dashboard

A discharge management dashboard can also be used to improve patient flow. It lists the same activities and timeframes on the patient itinerary but is intended for nurses and other ancillary staff that have a role in the patient discharge process. When a discharge task is overdue, the dashboard displays a signal to alert the staff that action needs to be taken. 

In addition to providing staff with visibility, the discharge management tool captures the reasons for late discharges. For example, if you’ve noticed that circumcisions being performed on the day of discharge are resulting in delays, the dashboard will provide the data you need to address this issue. 

Although it will take some time to get these tools implemented and used consistently, in the end, it’s worthwhile. Just imagine: it’s 10:00 a.m. on a weekday morning, and of the 20 discharges today, only three remain. The early morning induction and Cesarean patients are resting comfortably in their postpartum beds, and the triage unit is moving patients into L&D. Life is beautiful. 

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