Lehigh Valley Health Network

Two adjacent hospitals merged and grew patient volume by 40% on their Medical/Surgical and Cardiac units. To manage the increase, the project team at LVHN investigated opportunities to improve patient flow and staff satisfaction. About 550 patients per month were being discharged between the two units.

The LVHN project team discovered a consistent challenge during similar hours of the day when they examined their data over a 14-month period. With Minitab’s Dotplot shown in Figure 1 below, they were able to see that 95% of discharges and 57% of admissions happened between 10 a.m. and 8 p.m.

You show this to any nurse in the world and they’ll probably say, ‘So what? We know this. We live this,’” said Paul Kelly, the Black Belt on the project team. “But it was a turning point for us because they saw the data I was seeing and visually they could confirm, ‘Wow, this is a really important part of our day where we have to be at our most efficient. We’ve got a lot of traffic coming in these 10 hours. We’re not only discharging 95% of patients. We’re doing over half our admissions during those hours and on top of that we’re caring for patients.’”

What could the team deploy that could better manage these “rush hours” for unit staff? Initially, Length of Stay (LOS) data was presented for 57 different discharge locations, as shown in Figure 2 below with length of stay on the y-axis and discharge codes on the x-axis. The team wanted to simplify this, and Minitab’s recoding functionality made the LOS data much easier to interpret.

When they recoded the 57 discharge locations into three groups, as seen in Figure 3 below, the team asked themselves: Should they focus on the higher LOS discharge locations or where more patients were being discharged to? More patients were discharged to their homes, but their LOS was the lowest of the three groups, so may have less impact overall. Highest LOS were discharges to Skilled Nursing Facilities (SNF), but the number of patient discharges to Skilled Nursing Facilities were lower.

LVHN’s solution targeted all discharge locations, because they thought a once-deployed solution in the past could be useful again. Nursing management deployed two Admission/Discharge Registered Nurses (RNs) to assist nurse colleagues who had direct patient care responsibility with their admissions and discharges.

Over a 13-month period, the Admission/Discharge RNs performed 30% of all admissions and discharges on two units. This off-loading of value-added work allowed admissions and discharges to take place earlier for patients.

Minitab’s Histogram was the primary visual method to keep track of progress and if gains were sustained. The latest discharge times, from 6 p.m. to midnight, were of most interest to the team to reduce. Recoding 24 hours in the day to four 6-hour groups allowed the team to track the change in earlier-in-the-day discharges (see Figure 4).

They observed the largest improvement – 13.6% – with discharges to SNFs during the last 6 hours of the day coming down from 42.7% to 29.1%. Home and Other discharge categories also saw reductions in late discharges: