Emergency department overcrowding and high inpatient occupancy levels can significantly impact patient safety and quality of care. Limited bed availability affects the timeliness of essential care provision and can endanger the reliability and availability of necessary services. In 2016, The Mount Sinai Hospital implemented its “discharge before noon” initiative as part of a strategic plan to maximize hospital throughput and improve patient safety, from admission to discharge, by reducing ED overcrowding and expanding overall hospital capacity.
To achieve this, Mount Sinai increased communication pathways, implemented a multidisciplinary team approach to patient-centered care and created and executed a hospital-wide surge plan. Transparent communication and technological measures allowed the institution to benchmark against “self” and enhance visibility of progress through dashboard and reporting metrics. Knowledge exchange between members of multidisciplinary teams not only fostered team-building, but was needed to best implement sustainable discharge-before-noon strategies. Multiple patient flow techniques were devised and implemented throughout the institution to reduce throughput barriers and capacity constraints, further fostering a hospital community of cooperation and collaboration.
Mount Sinai achieved progressive annual increases in discharge-before-noon percentages, from 16% in 2015 to 25% in 2018. There was a 31-minute shift in median discharge time over a four-year period, from 14:51 in 2015 to 14:20 in 2018. The hospital saw a 40% improvement in “average bed ready to bed occupied for critical care” transfers, from 2.0 hours in 2015 to 1.2 hours in 2018.
For more information, contact Helen Brannon, MSN, MBA, RN, vice president, system command center and throughput operations, at (516) 413-9177 or firstname.lastname@example.org.