A STUDY ON THE DISCHARGE PROCESS IMPROVEMENT IN A TERTIARY CARE HOSPITAL AT COIMBATORE
Dheebika.G, MBA, KCT Business School, Coimbatore dgdheepak07@gmail.com
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ABSTRACT
In the present competitive world, quality of health care is playing an important role in the modern society. Among various factors affecting the health care system, discharge process is one of the important factors related to patient satisfaction. Hospital discharge process is one of the very lengthy procedures. The process of discharging patients is complex requiring the coordination of multiple different groups including physicians, nurses, ancillary service staff, patients, their families and in some settings the finance/billing department.
Creating a more
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From the results obtained it clearly stratifies two different factors contributing to the delay in the discharge process i.e the time taken for billing and time taken for the ready of the discharge summary. The factor of the ready of the discharge summary is directly connected with the CRRI and their availability.
The maximum time limit according to NABH and lower control limit is set to be 1 hours for each categories. On the whole of 401 discharges monitored, only 71discharges where falling under the category of discharges happening within 3 hours. This shows that the process is critically unstable. Hence the time taken for the patient’s discharge is more for the general ward than the special ward. The time taken for billing almost takes about 4 hours for the special ward patients and the time taken for billing almost takes about 5 ½ - 6 ½ hours for the general ward patients. SUGGESTIONS
• Planned discharges will make the entire process to move in a smoother
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A clinician can start the day with a complete view of new patients and those scheduled for discharge. It’s also easy to view patient vital signs, order status, panic value alerts and approval orders. Built-in notes make it easy to collaborate with other members of the care team within the app. Similarly the Message for Healthcare app keeps care teams connected while ensuring patient information is secure. Message for Healthcare makes it easy to send and receive text messages, photos and voice memos — even sync data between different devices. With fewer communication lapses, patient discharges are more efficient, and care is
We are imposing a timeframe on hospitals that we cannot control. If the SA believes the patient needs a Certificate of Hold, why impose limits on the hospital?
These are considered to be the admission units, an assessment is then completed. Once patients are treated and symptoms have resided within 30 days patients are released to resume their lives. In addition to, 50% of the people admitted are discharged back into our society. On the other hand, if people are admitted they are moved to other units. When patients are experiencing a crisis moment all available help is needed.
Medical technologies and apps are relevant to solving most of the challenges affecting Suburban Independent Clinic(SIC). The implementation of mobile technologies will improve the efficient and effective delivery of care to the patients visiting the clinic. Mobile devices and its application will facilitate SIC patients to have 24/7 access to their medical records, refill their prescriptions, complete medical forms online, send emails and video chat with their doctors, thus leading to a better opportunity of managing their conditions. Patients will have other options available for scheduling their appointments. With improved mobile technology and apps, patients could schedule their appointments using text messaging, email, web app.
Then I just happened to find out about the way the nurses have the big say as to who gets discharged and who doesn’t” (Kesey 166). Kesey uses the
Overall, patients are going to be rendered more diagnosis-centered care, with an interdisciplinary look at each case inpatient, as well as outpatient. Patients will be given a work-up and plan for success, no longer as a “quick-fix”, but a long term plan of care to control chronic diseases outside of the acute care setting. Looking at a study from Connecticut, “By revamping the discharge process and working with post-acute providers, UConn Health Center/John Dempsey Hospital, Farrington, CT, reduced thirty-day heart failure readmissions from 25.1% in August 2010 to 17.1% in March 2012. Key initiatives included follow-up appointments within seven days in the hospital heart clinic, revising nursing education, adding automated dietician, social worker, pharmacy, and cardiology consults with the diagnosis order set, and collaborating with the community providers to smooth the transition of care” (“Hospital Initiative”, 2012).
Hope is not lost for our nations veterans, there are initiatives that may be implemented in order to improve the quality of care. We have identified four key areas that we feel will improve the quality of care for our nations veterans. These areas are; Patient Aligned Care Teams (PACTS), the program of vocational rehab, positive media relations, and universal electronic medical records. PACTS are formed when a veteran works together with multiple care disciplines in order to achieve whole person care and sustain life long wellness (VHA, 2015). These teams focus on patient medical partnerships, access to care, coordinated care among disciplines, and team based care with the veteran as the focus (VHA, 2015).
Hayes learned that the vast majority of the patients only used Boardwalk Clinic during the times when their current caregivers were unavailable and they planned on returning to their current medical providers during traditional business hours. Thus, patients that need services during nontraditional hours most likely chose Boardwalk Clinic as their second choice, only because their first choice was not available. Although Dr. Hayes and her colleagues had a better understanding of the retention issue, they were still at a loss as to what steps the clinic could take to attract those patients in the Chelsea marketplace who already had relationships with other healthcare providers to make Boardwalk their first choice. There are a couple steps Boardwalk Clinic could take to ensure an increased rate of patient retention.
“Concept clarification is an important step in developing useful and useable knowledge in nursing science.” (Tofthagen, 2010). Within the home health field of nursing one of the major and most significant concepts is team work. Simply stated, concept analysis incorporates a method or approach by which concepts that are of interest to a discipline are examined in order to clarify their characteristics or attributes” (Cronin, 2010). Within a home health care team there are Registered Nurses, Physical Therapists, Home Health Aides, Medical Social Workers, Managed Care Coordinators, and Clinical Managers.
However, the metric indicate that aspects such as consumer convenience and efficient handling of the patients have been noted. On the other hand, most of the employees are developing resistance towards the new system due to the high level of accountability required. The report therefore looks into the suitable decision that the hospital management should consider. What are the key decisions that have to be made at GGH?
Kaiser Permanente has been equipped since 2007 with Health Connect; which is the largest private electronic health record implementation in the world. This is a highly sophisticated electronic program that integrates inpatient, outpatient, and clinic medical records with appointments, registration, pharmacy, and billing for all kaiser members. In addition, this electronic program includes an entire medical library with a whole set of care support tools which are accessible to doctors, nursing staff and patients (Kaiser Permanente, n.d.). At kaiser permanente; nurses are expected to print out “the after-visit summary” (AVS), which contain the doctor recommendations for each patient that we see.
EHRs enables physicians to access patient information anywhere from devices such as smartphones, laptops, and tablets. This can lead to increased risk of patient data being given into the wrong hands. Providers need to be cautious and make sure that patients are receiving information via email or text message
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Power has varied definitions. According to Mullins power is considered as having control, influence or dominion over something or resources (Mullins, 2002).As stated by Benner” Power includes caring practices by nurses which are used to empower Patients” (Benner, 2001) . Ideally, nursing leaders must have knowledge and abilities which are strong in the multi-factorial domains of nursing practice (E.A. Ward, 2001).The challenge of leadership is all about how leaders can channel their subordinates to get things accomplished. It is about transforming ideas into actions, dreams into realities, and problems into solutions and hurdles into positive outcomes (Kouzes J. M., & Posner, B. Z. 2015). the power in the leader that encourages
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