Improving discharge times for patients admitted for allogeneic stem cell transplantation.
Authors: Maheshwari Shipra , Schlefman Jenna , Jones Caroline , Burgess Isabel , Guishard Alecia , Grubbs Carly , Kauffman Judy , Whitman Andrew , Campbell Grace , Keng Michael Kenneth 
Published: September 2024

290

Background:
Among patients admitted for allogeneic stem cell transplant (SCT) at University of Virginia (UVA) Health from 01/2022 through 12/2022, 0% were discharged by noon, even when discharge was anticipated. The discharge of SCT recipients is dynamic, impacted by events occurring throughout admission. Delays in discharge can result in patient/provider dissatisfaction, postponed admissions, additional costs, and poor utilization of healthcare resources.
Methods:
A multidisciplinary team of licensed providers, pharmacists, nurses and key stakeholders in the SCT program attended ASCO’s Quality Training Program in 2023, with the aim of increasing the percentage of patients discharged by noon to 20%. After review of baseline data and development of current and ideal process maps, the team distributed a survey to the department to identify perceived sources of delay. Results were corroborated with baseline data and arranged into a pareto chart and priority matrix to synthesize an action plan. The most commonly identified causes for discharge delay included: medication delivery time, complex medication issues, and delay in placing the discharge order.
Results:
From 10/2023 through 12/2023, the first PDSA cycle focused on anticipation of discharge and prompt placement of the discharge order, which was identified as a process measure. A discharge checklist was created via EPIC smartphrase and incorporated into daily progress notes. Data analysis demonstrated no change in the percentage of patients discharged by noon, but did show numerical improvement in the average time of discharge order placement and discharge time. The second PDSA cycle from 01/2024 through 05/2024 involved standardization of the team responsible for discharging SCT patients, with continued use of the smartphrase. Subsequently, the percentage of patients discharged by noon increased to 14.3%, with significant improvement in the time of discharge order placement and discharge time from baseline (see Table).
Conclusions:
Through implementation of quality improvement concepts, our team was able to improve our process measure of discharge order placement time. While we have made strides in regards to our outcome measure of percentage of patients discharged by noon, we have not met our goal yet. With continued progress and consistent auditing, we may see improvements in length of stay, bed availability, and financial burden. Future PDSA cycles are planned with an emphasis on medication delivery time.

Key times during discharge for patients admitted for allogeneic stem cell transplantation.

Mean
Baseline
PDSA 1
PDSA 2
p-value (PDSA 1 and PDSA 2)

Discharge Order Time
11:46 AM
11:09 AM (p ≤ 0.304)
9:32 AM (p ≤ 0.0001)
p ≤ 0.023

Discharge Time
4:20 PM
4:03 PM (p ≤ 0.559)
3:08 PM (p ≤ 0.022)
p ≤ 0.239

Length of Stay (days)
26.8
25.9 (p ≤ 0.647)
26.6 (p ≤ 0.898)
p ≤ 0.663

Medication Delivery Time
2:18 PM
1:00 PM (p ≤ 0.054)
12:18 PM (p ≤ 0.002)
P ≤ 0.402