Gap Analysis of Discharge Process at Yashoda Hospital, Sanjay Nagar
Hospital discharge processes play a critical role in patient care. This study examines gaps in discharge procedures at Yashoda Hospital, focusing on patient categories and operational improvements. The aim is to provide insights for enhancing patient care quality and identifying reasons for discharge delays.
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Gap analysis of discharge process at Yashoda Hospital, Sanjay Nagar, Ghaziabad. BY- Dr. Bhavyashi Bhardwaj Roll no. PG/22/021 Guided by- Dr. Sumesh Kumar
Introduction Every hospital s patient release procedure is a multi-step process that involves numerous personnel and departments. These processes influence and have an impact on the patient discharge procedure. Following NABH principles, consistency in structures and procedures, tactical and prompt service planning (year reviews, monthly feedback), and other factors are significant components of such a strategy. The purpose of this study was to examine the discharge process for patients who were admitted to the hospital in one of three patient categories: Private, Panel, or TPA. It is crucial for hospitals that patients who are admitted are released from their care in a safe and efficient manner that is advantageous to both the patients and the organization.
As per B.M. Sakharkar (The Author of Principles of Hospital Administration and Planning ), Discharge is the release of an admitted patient from the hospital . As per NABH, Discharge is a process by which a patient is shifted out from the hospital with all concerned medical summaries ensuring stability . When the consultant determines that the patient is well enough to continue receiving home care services or needs to be transferred to a different category of facility (rehabilitation, mental), the discharge process begins.
Aims and objectives AIM Tostudy the process of discharge and analyze the gaps and scope of operational improvement in the discharge process at Yashoda Hospital, Sanjay Nagar, Ghaziabad. Primary Objective Secondary objective To provide suggestions for operational improvement and improve quality of patient care. To access the discharge time for Cash, Panel and TPA patients and find actual cause of delay.
Methodology Study design A cross sectional study based on Observation and on process mapping and Quantitative research enumerating the percentage of discharges within time and enumerate analyses i.e., the time span of each of the steps for discharge as well as various elements leading to discharge on or off time. Study area- IPD area of Yashoda Superspeciality Hospital and cancer institute that includes private, semi-private, general and onco-surgical wards. Sampling method Purposive Sampling
Cash patients- 20 Panel patients- 20 TPA patients 20 Sample Size- 60 patients Data collection tool- Participant observation Study Duration 1 month Inclusion Criteria IPD patients who are admitted in the ward of the hospital Exclusion Criteria Patients of daycare department, ER, SICU, LAMA discharges.
DISCHARGE ADVISED BY CONSULTANT PREPARATION OF ROUGH SUMMARY RMOs write the discharge notes Medicine return/indent Physiotherapy and diet counseling done. Pending report collection if any. PREPARATION OF FINAL SUMMARY PROCESS MAPPING FILE SENT TO BILLING DEPARTMENT GATE PASS ISSUED BY BILLING DEPARTMENT GATE PASS RECEIVED IN WARD DISCHARGE SUMMARY AND GATE PASS PROVIDED TO THE PATIENT
Results TYPES OF DISCHARGES 40% No. Of planned discharge No. Of unplanned discharge 60%
Results DISCHARGE TIME FOR CASH PATIENTS DISCHARGE TIME FOR PANEL PATIENTS DISCHARGE TIME FOR TPA PATIENTS MAXIMUM MAXIMUM MAXIMUM DISCHARGE TIME IN HOSPITAL POLICY DISCHARGE TIME IN HOSPITAL POLICY DISCHARGE TIME IN HOSPITAL POLICY AVERAGE AVERAGE AVERAGE MINIMUM MINIMUM MINIMUM 5:59 5:56 9:13 4:46 2:42 2:41 2:30 4:00 2:00 1:01 0:50 1:32 Average time taken for discharge of CASH patient is 2 hours and 42 mins. Average time taken for discharge of PANEL patient is 2 hours and 41 mins. Average time taken for discharge of TPA patient is 4 hours and 46 mins.
RESULTS REASON FOR DELAY IN CASH PATIENTS REASON FOR DELAY IN TPA PATIENTS REASON FOR DELAY IN PANEL PATIENTS DELAY IN RECEIVING DISCHARGE MEDICINE DELAY IN SENDING FILE TO MT ROOM DELAY IN APPROVAL DELAY IN RECEIVING GATE PASS UNAVAILABILITY OF CONSULTANTS TO SIGN SUMMARY UNAVAILABILITY OF CONSULTANT TO SIGN DISCHARGE SUMMARY MULTIPLE CORRECTIONS IN DISCHARGE SUMMARY DELAY IN RECEIVING GATE PASS 2:40 0:37 1:11 0:34 0:59 0:51 0:26 1:04
TPA PATIENTS CONSULTANT MISTAKE IN DISCHARGE SUMMARY NO FIXED TIME FOR ROUNDS LAST MOMENT CONSULTATION FUNDS UNPLANNED DISCHARGES QUERY ARRANGEMENT DELAY IN APPROVALS ARRANGEMENT OF TRANSPORTATION UNAVAILABILITY TO SIGN SUMMARY UNAVAILABILITY OF ATTENDANTS WORKLOAD DELAY IN DISCHARGE PROCESS MULTIPLE CORRECTIONS IN FINAL SUMMARY DELAY IN RECEIVING GATE PASS ERROR IN PNEUMATIC SHOOT GLITCH IN HIS ERRORS IN BILLS ABSENCE OF MT ON FLOORS DELAY IN RECEIVING DISCHARGE MEDICINE DELAY IN WRITING DISCHARGE NOTES BY RMO DELAY IN SENDING FILE TO MT ROOM BILLING PHARMACY DISCHARGE SUMMARY
DISCUSSION Discharges should be planned. Consultant rounds should be done on time. Coordination between nursing staff is important. Giving priority to TPA patients as they take most time in receiving approval. Discharge medicines should be received on time. RMO s should prepare discharge notes on time.
In cashless patients, documents should be collected with the time so that the nurse doesn t have to rush to collect reports or clearances. Interdepartmental coordination and communication (Training, sensitization, meetings, communication channel) Timely report collection & departmental clearance. Training of Nurse to prepare Discharge Summary. Delay in GDA services in transporting the discharged patient and arranging the wheelchair for the same.
CONCLUSION Discharging patients appropriately is complicated. Effective and well- timed discharge can be attained by interdepartmental coordination and proper communication between all involved in the process of discharge. It has been found that the Time taken for discharge of Cash patients, is 2 hours 42 mins, which is 42 minutes more than the hospital policy. For Panel patients, a delay of 41minutes has been found. For TPA patients, a delay of 46 minutes has been found. Unplanned Discharges are the main reason for the chaos in the Discharge Process. In NABH Chapter 1, AAC 13 mentions that the Discharge should be planned in consultation with the patient/ family.
LIMITATIONS Only IPD patients who are admitted to the wards are included. The absence of a proper Hospital Management Information System (HMIS) and electronic medical record system in hospitals leads to inefficiency in data collection and coordination.
REFERENCES Sakharkar BM. Principles of Hospital Administration and Planning. 2nd ed. New Delhi: Jaypee Brother; 2009. Goel S.L and Kumar R. Hospital Administration and Planning, 1st edition, Jaypeee Brothers, Medical Publishers Pvt Ltd: New Delhi https://www.yashodahealthcare.com https://www.ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_2135.pdf https://www.nabh.co/images/Standards/NABH%205%20STD%20April%202020.pdf https://www.jrfhha.com/doi/JRFHHA/pdf/10.5005/jp-journals-10035-1113 https://pubmed.ncbi.nlm.nih.gov/18195405/ https://journals.indexcopernicus.com/search/article?articleId=2153764 https://pubmed.ncbi.nlm.nih.gov/21740345/ https://www.researchgate.net/publication/273340797_Role_of_discharge_planning_and_other_det erminants_in_total_discharge_time_at_a_large_tertiary_care_hospital https://pubmed.ncbi.nlm.nih.gov/26845068/
