Journal of Patient Safety & Quality Improvement

Journal of Patient Safety & Quality Improvement

Investigating the Prolonged Discharge Process in Pediatric Teaching Hospital of Tehran, Iran: A Cross-Sectional Study

Document Type : Original Article

Authors
Sodabeh Vatankhah 1
Azam Choopani 1
Emir Tahmazi Aghdam 1
Mohammad Esmaeel Tavakoli 1
Nasrin Joudyian 2
Hamideh Nafar 1
1 Department of Healthcare Services Management, School of Health Policy, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
2 Department of Healthcare Services Management, School of Health Policy, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
10.22038/psj.2023.66503.1366
Abstract
Introduction:
This study aimed to investigate the factors contributing to prolonging the discharge process in a pediatric teaching hospital.
 
Materials and Methods:
The present study was a descriptive cross-sectional study carried out on 300 patients discharged from one of the pediatric teaching hospitals in Tehran in 2019. This study was conducted using a mixed method. In the quantitative stage, the statistical form was used, the average discharge time in different hospital wards was measured using the stopwatch method, and the data were analyzed using SPSS V. 25 software and descriptive statistics. A qualitative approach was used, including observations, file reviews, Focus Group Discussion (FGD), and brainstorming with experts from the Quality Improvement Office, ward secretaries, clearance unit experts, pharmacy experts, and ward supervisors, to identify the causes of the prolonged process. Finally, the factors were prioritized and approved using the nominal group method.
 
Results:
The average discharge time was 3 hours and 7 minutes; the shortest discharge time belonged to the blood ward, and the longest was to the kidney ward. The causes of delay in discharge were divided into two categories: organizational and human factors.
 
Conclusion:
To improvethe the quality of the discharge process and patient satisfaction, solutions such as having assistants write file summaries before the morning round, sending files out of the ward on time, hiring a circular secretary to collect patients' files from various wards, and controlling them using a standard checklist, nurses' training, and continuous supervision were proposed.
Keywords
Discharge Process
Iran
Pediatric Hospital
Subjects
  1. Vanaki Z, Habibipour B. The assessment of effect discharge planning on patients satisfaction. Avicenna Journal of Nursing and Midwifery Care. 2008;16(2):25-35.
  2. El-Eid GR, Kaddoum R, Tamim H, Hitti EA. Improving hospital discharge time: a successful implementation of six sigma methodology. Medicine. 2015;94(12).
  3. Nezhad Jafari N, Khatibi T. Prioritizing the causes of disruption in the discharge process of hospitalized patients[in Persian]. International conference on industrial engineering and management2016.
  4. Van Emden DMD, Ros WJ, Berns MP. Transition of care: an evaluation of the role of the discharge liaison nurse in the Netherlands. Journal of Advanced Nursing. 1999;30(5):1186-94.
  5. Fazel asl N, Ghaffari F, Nasiripour AA. Determining Factors On Hospital Discharge Process Via Data-Mining Method Administered At Shahid Modares Hospital, Tehran. Payavard-Salamat. 2018;11(5 #M00225):-.
  6. Henwood M. Effective partnership working: a case study of hospital discharge. Health & social care in the community. 2006;14(5):400-7.
  7. Ebrahimipour H, Vafaei NA, Nouri GA, Esmaeili H, Jamili S. Studying waiting time of patient during discharge process in clinical departments of Imam Reza hospital affiliated with Mashhad University Of Medical Science In 2014. 2015.
  8. Yarmohammadian M, Khosravizadeh O, Alirezaei S, Doosty F. Impact of business process model on improving the discharge process in teaching hospital of Ghaem, Mashhad. Journal of Health Administration (JHA). 2015;18(61).
  9. Patel H, Yirdaw E, Yu A, Slater L, Perica K, Pierce RG, et al. Improving early discharge using a team-based structure for discharge multidisciplinary rounds. Professional case management. 2019;24(2):83-9.
  10. Zoucha J, Hull M, Keniston A, Mastalerz K, Quinn R, Tsai A, et al. Barriers to Early Hospital Discharge: A Cross-Sectional Study at Five Academic Hospitals. Journal of hospital medicine. 2018;13(12):816-22.
  11. Ragavan MV, Svec D, Shieh L. Barriers to timely discharge from the general medicine service at an academic teaching hospital. Postgraduate medical journal. 2017;93(1103):528-33.
  12. Finn KM, Heffner R, Chang Y, Bazari H, Hunt D, Pickell K, et al. Improving the discharge process by embedding a discharge facilitator in a resident team. Journal of hospital medicine. 2011; 6(9): 494-500.
  13. Rohatgi N, Kane M, Winget M, Haji-Sheikhi F, Ahuja N. Factors associated with delayed discharge on general medicine service at an academic medical center. The Journal for Healthcare Quality (JHQ). 2018;40(6):329-35.
  14. Harlan GA, Nkoy FL, Srivastava R, Lattin G, Wolfe D, Mundorff MB, et al. Improving transitions of care at hospital discharge—implications for pediatric hospitalists and primary care providers. Journal for Healthcare Quality. 2010;32(5):51-60.
  15. Wu S, Tyler A, Logsdon T, Holmes NM, Balkian A, Brittan M, et al. A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children. Pediatrics. 2016; 138(2): e20143604.

 

 

Journal of Patient Safety & Quality Improvement
Volume 11, Issue 1
Winter 2023
Pages 49-53