Abstract:
A system and method for improving patient discharge from a healthcare facility automates several areas of the patient discharge process, using automatically placed contacts with communications devices. The system includes a website that is accessible by registered users, primarily nurses and physicians. Critical elements of patient discharge, currently requiring many telephone calls between nurses and other personnel are converted to a largely automated “discharge cascade.” The cascade is initiated by the patient&#39;s nurse a predetermined period, for example, 24 hours, prior to a possible discharge, via the website. The website initiates an automatic communication with any or all involved physicians with a scripted, interactive call to elicit physician approval for the discharge. If the physician approves the discharge, a secondary set of automated communications are made to downstream parties, such as nursing operations, housekeeping, patient transport, home health, pharmacy, and patient family member.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims priority to provisional application Ser. No. 60/780,417, filed Mar. 8, 2006, entitled “Patient Discharge System and Associated Methods.” 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The present invention relates to systems and methods for improving process flow within a healthcare facility, and, more particularly, to such systems and methods for improving a process associated with discharging patients from a hospital. 
         [0004]    2. Description of Related Art 
         [0005]    A shortage of hospital beds is a chronic problem for many hospitals, and can result in reduction in patient services, cancellation of elective, well-paying procedures, poor use of nurse and physician time, and emergency room crowding, among other difficulties. While more beds can be made available by building larger hospitals and hiring more staff, this is an expensive and usually long-range solution. 
         [0006]    One of the chief bottlenecks in hospital patient processing is in the area of patient discharge, which in the present state of the art can require multiple telephone calls between nurses and physicians, nurses and pharmacists, nurses and ancillary personnel, and nurses and patient family members. Frequently the rate-limiting step in the process is the requirement for the physician to be physically present at the patient&#39;s bedside to authorize the patient&#39;s release. In addition, contacting a home health agency, when needed, is often done at the last minute and can result in additional delays. 
         [0007]    Although there is known to exist a software package that can trigger an alert when a bed becomes available, there remains a need to increase the efficiency of the entire patient discharge process. 
       SUMMARY OF THE INVENTION 
       [0008]    It is therefore an object of the present invention to provide a system and method for improving patient discharge from a healthcare facility. The system and method automates several areas of the patient discharge process, using automatically placed contacts with communications devices. If hospital discharges can be accelerated to occur earlier in the business day, less manpower is needed, greater numbers of beds become available for patient use on a real-time basis, and revenue is increased. 
         [0009]    The system includes a website that is accessible by registered users, primarily nurses and physicians. Critical elements of patient discharge, currently requiring many telephone calls between nurses and other personnel are converted to a largely automated “discharge cascade.” The cascade is initiated by the patient&#39;s nurse a predetermined period, for example, 24 hours, prior to a possible discharge, via the website. The website initiates an automatic communication with any or all involved physicians with a scripted, interactive call to elicit physician approval for the discharge. 
         [0010]    If the physician approves the discharge, a secondary set of automated communications are made to downstream parties, such as nursing operations, housekeeping, patient transport, home health, pharmacy, and patient family member. 
         [0011]    The features that characterize the invention, both as to organization and method of operation, together with further objects and advantages thereof, will be better understood from the following description used in conjunction with the accompanying drawing. It is to be expressly understood that the drawing is for the purpose of illustration and description and is not intended as a definition of the limits of the invention. These and other objects attained, and advantages offered, by the present invention will become more fully apparent as the description that now follows is read in conjunction with the accompanying drawing. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]      FIG. 1  is a system schematic of the patient discharge process of the present invention. 
           [0013]      FIG. 2  is a communications flowchart of the patient discharge process. 
           [0014]      FIG. 3  is a flowchart of the steps of the patient discharge process. 
           [0015]      FIG. 4  is an exemplary screen displaying a patient list and associated data. 
           [0016]      FIG. 5  is an exemplary screen displaying selection of the “orders” tab. 
           [0017]      FIG. 6  is an exemplary screen displaying a list of discharge types. 
           [0018]      FIG. 7  is an exemplary screen including a “new result” column. 
           [0019]      FIG. 8  is an exemplary screen displaying active orders. 
           [0020]      FIG. 9  is an exemplary screen displaying a list of responding physicians. 
           [0021]      FIG. 10  is an exemplary screen displaying the most recent responding physician. 
           [0022]      FIG. 11  is an exemplary screen displaying a complete list of responders. 
           [0023]      FIG. 12  is an exemplary screen showing a negative result with a red flag. 
           [0024]      FIG. 13  is an exemplary screen displaying a complete list of responders, including a negative responder. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0025]    A description of the preferred embodiments of the present invention will now be presented with reference to  FIGS. 1-13 . 
         [0026]    An exemplary embodiment of the system  10  ( FIGS. 1 and 2 ) and method  100  ( FIG. 3 ) are mediated by a software package  11  that is resident on a processor  12  that will typically be located at the hospital site  13 , although this is not intended as a limitation. The processor  12  is in signal communication with a plurality of sites within the hospital  13 , for example, workstations at nurses&#39; stations  14 , pharmacy  15 , housekeeping  16 , patient transport  17 , and hospital administration  18 . Each of the workstations  14 - 18  will require a secure login for access. The processor  12  is also adapted to establish signal communication with sites outside the hospital  13 , such as physician communication devices  19  (cell phone, personal data assistant, personal computer, etc.), family member communication devices  20 , home health care agency  21 , and external pharmacy  22 . The processor  12  is also in signal communication with a database  23  containing patient and physician data, such as contact information. In a particular embodiment, the system  10  functions over a service-oriented architecture for establishing secure communications over a plurality of communication pathways. 
         [0027]    The software package  11  comprises a plurality of code segments that are adapted to mediate the relevant method steps of the invention. The method  100  ( FIG. 3 ) includes the step of determining that a patient may be ready for discharge in a predetermined time period, for example, 24 hours (block  101 ). This determination is typically made by a nurse, although this is not intended as a limitation. The nurse logs into the system  10  (block  102 ) and initiates the automated discharge process (block  103 ) by selecting from a list of patient names (block  104 ) and accessing discharge-related data (block  105 ) such as the name and contact information for: the patient&#39;s admitting physician, any consulting physicians involved in the patient&#39;s care, a responsible family member or other party who will retrieve the patient, the patient&#39;s chosen pharmacy, and a home health agency (selected on the basis of patient insurance company and geographic location, by, for example, zip code). The patient&#39;s current medication list is also accessed, and can serve as a draft of a patient discharge medication list for the discharging physician(s). 
         [0028]    Typically the data on the patient&#39;s admitting physician, responsible family member, pharmacy, and home health agency are available as of the admission process. The remaining data will likely change during the hospitalization. 
         [0029]    The system  10  then automatically attempt to contact the admitting physician (block  106 ), for example, via his/her cell phone. A prerecorded message is sent by the system  10  (block  107 ), with an interactive script (block  108 ), for example: “Hello, Doctor (doctor&#39;s name).” The doctor must establish secure communication by speaking into his/her communication device (block  109 ), so that an interactive voice recognition (IVR) protocol can determine that the speaker is indeed the doctor being sought (block  110 ). If not, the system  10  terminates the call (block  111 ). 
         [0030]    If the IVR determines that the correct person has been reached (block  110 ), the script continues (block  112 ) with a prompt such as: “The nurse (nurse&#39;s name) for your patient (patient name) has indicated that hospital discharge may be possible in 24 hours. If you agree, and wish to initiate the hospital discharge cascade, press 1. If you disagree, press 2. If you wish to speak with the nurse, press 3.” This last option initiates a call to the nurse (block  113 ). 
         [0031]    If the physician presses 1, an interactive, autodialed prerecorded call is sent to all consulting physicians (block  114 ), with a similar script. This doctor must also establish secure communication by speaking into his/her communication device (block  115 ), so that the IVR protocol can determine that the speaker is indeed the doctor being sought (block  116 ). If not, the system  10  terminates the call (block  117 ). If the consulting physician has been reached correctly (block  116 ), the system  10  then continues with a script (block  118 ) such as: “The admitting physician, Dr. (admitting physician name) has indicated that his/her patient (patient name) will be ready for discharge in 24 hours. If you agree with this hospital discharge, press 1. If you wish discharge to be withheld, press 2.” 
         [0032]    If either the admitting or consulting physician presses 2, the system  10  is so updated, and the discharge cascade is terminated (block  119 ). If the admitting and all the consulting physician(s) press 1, the discharging physicians are required to review and alter as necessary the patient&#39;s medication list (block  120 ). 
         [0033]    The discharge cascade continues by initiating a plurality of communications, including autodialed calls, pages, emails, and/or faxes. For example, within the hospital  13 , prerecorded messages can be sent to nursing operations  14 , patient transport  17 , social work, etc. (block  121 ). These calls can be initiated at any time respectively deemed appropriate during the discharge sequence. Communications outside the hospital  13  can include calls to the patient&#39;s responsible relative or other responsible party  20 , informing them of the patient&#39;s possible discharge (block  122 ), and of the time of pickup. If appropriate, the home health agency  21  is also notified (block  123 ), as well as the patient&#39;s pharmacy  22 , transmitting a list of patient prescriptions (block  124 ) as mandated by the discharging physician(s) in block  118 . At the appointed time, the patient is discharged (block  125 ), and the hospital bed is vacated, which initiates housekeeping activities, etc., prior to bed re-use (block  126 ). 
         [0034]    Preferably a reporting function is included in the system  10 , wherein all contacts are recorded (time and party), and when discharge-related activities were carried out by that party. Such reporting can serve several purposes, including providing data that can be analyzed for the purpose of achieving process improvement and for providing an audit function. 
         [0035]    An exemplary set of screens ( FIGS. 4-13 ) illustrates the steps taken by the hospital-site user. After a secure log-in, the system  10  brings up a patient list on a screen  50  such as shown in  FIG. 4 . On the list are shown the assigned location  51  for each patient  52 , as well as ID information  53 , visit status  54 , gender  55 , age  56 , healthcare provider  57 , and reason for visit  58 . On the far left is a “check orders” column  59  with indicators such as a green flag  60  or a red flag  61  with an exclamation point thereon. 
         [0036]    In the next screen  62  ( FIG. 5 ), the user has selected the “orders” tab  63 , and entered “discharge.” The screen  64  of  FIG. 6  provides a list of discharge types; here, the “discharge tomorrow—request approval” item  65  is selected, which initiates the discharge cascade for the selected patient. 
         [0037]    When the doctor responds via the IVR system, a “new result” column  66  appears on the screen  67  of  FIG. 7 , here a green flag  68 , indicating that the contacted doctor Abraham  69  has approved the discharge. If this sequence has occurred during business hours, the order becomes active, as shown in the screen  70  of  FIG. 8 . Selecting the “Results” tab  71  brings up the screen  72  of  FIG. 9 , which displays a list  73  of the responding physicians and their responses to the query  74  in the first column. This screen  72  can also be called up by double-clicking on the flag  68  in  FIG. 7 . The screen  75  of  FIG. 10  displays the most recent physician  76  responding, and clicking on the “H”  77  brings up a complete list  78  of responders on the screen  79  of  FIG. 11 . 
         [0038]    If a physician responds negatively, or cannot be contacted, the “new results” flag  80  on the screen  81  of  FIG. 12  is red. Selecting that flag  80  again brings up the list  82  of responders in the screen  83   FIG. 13 , showing that, when Dr. Margolis was contacted, he recommended not releasing the patient on the next day. 
         [0039]    The system  10  and method  100  of the present invention measurably shift hospital discharge times into an earlier part of the day, creating greater bed availability. The workload of nurses and physicians is reduced by automating the redundant but necessary components of discharge, freeing them for direct patient care. This is achieved by permitting many of the process elements to occur in parallel, and by receiving physician instructions remotely, rather than waiting for the physician to appear at the patient&#39;s bedside. Thus discharge can become a gradual process, occurring over the entire day and at the physician&#39;s convenience. The physician is motivated to provide timely discharge in direct exchange for better use of his/her time and for increased freedom of action. The hospital benefits by obtaining use of the released bed earlier, and using staff more effectively. The patient benefits by being released in a timely fashion. 
         [0040]    It is to be understood that the present invention is not to be limited to the above exemplary embodiment, and that extension to other healthcare situations such as transfer between hospital departments (into and out of critical care, for example) can also benefit from such a system. 
         [0041]    In the foregoing description, certain terms have been used for brevity, clarity, and understanding, but no unnecessary limitations are to be implied therefrom beyond the requirements of the prior art, because such words are used for description purposes herein and are intended to be broadly construed. Moreover, the embodiments of the system and method illustrated and described herein are by way of example, and the scope of the invention is not limited to the exact details of implementation. 
         [0042]    Having now described the invention, the system, the operation and use of preferred embodiments thereof, and the advantageous new and useful results obtained thereby, the new and useful configurations, and reasonable equivalents thereof obvious to those skilled in the art, are set forth in the appended claims.