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SWAMI VIVEKANAND SUBHARTI UNIVERSITY [Established under U.P Govt. Act.

No. 29 of 2008 and approved under section 2(f) of UGC Act 1956] / PROTOCOL
FOR PROJECT STUDY ON A Study Of Discharge Time Of Patients At CSSH, Meerut
AT CHATRAPATI SHIVAJI SUBHARTI HOSPITAL, MEERUT Under The Supervision
Of DR. PRITI GOEL (Head Of Department) MBA (Hospital Administration)
Submitted By KESHAV KISHORE THAKUR MBA (Hospital Administration) 2018-
2020 TABLE OF CONTENT Introduction Need for the study Aim Objectives Review
of literature Methodology Bibliography INTRODUCTION A hospital is a health
care institution providing patient treatment with specialized medical and nursing
staff and medical equipment.

Hospital consists of departments, traditionally called wards, especially when they

have beds for inpatients, when they are sometimes also called as inpatient wards.
Wards are of different types A hospital mainly provides two types of services,
being outpatient and inpatient services. Out of which the outpatient is a person
who receives ambulatory care in the hospital, which do not requires an overnight
hospital stay. An inpatient is a person who has been admitted to a hospital for
purpose of receiving inpatient hospital services Health Low Professional Series
(2004). The inpatient in a hospital has to go through and experience three
different stages.

First is admission next is intervention and final stage is discharge. Discharge from
the hospital is the point at which the patient leaves the hospital and either
returns home or is transferred to another facility such as one for rehabilitation or
to a nursing home. Discharge time generally refers to the average time of patient
stay in the hospital after getting discharge by the doctors. There are many studies
going on, as o improves the discharge time of patient from the hospital.

It helps in increasing the quality of medical services provided to the patients.

Discharge from hospitals is the point at which the patient leaves the hospital and
either returns home or is transferred to another facility such as one for
rehabilitation or to a nursing home. Discharge involves the medical instructions
that the patient will need to fully recover.

Discharge planning is a service that considers the patients’ needs after the
hospital stay, and may involve several services such as visiting nursing care ,
physical therapy, and home blood drawing. During the discharge of the patient,
after the necessary intervention, a number of procedures have to take place by
engaging various staff members and departments making the process complex.
As per Mogli, “Discharge is the release of a hospitalized patient from the hospital
by the admitting physician after providing necessary medical care for a period
deemed necessary”.

As per Shakharkar, “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 ensuring stability. The discharge
process is deemed to have stated when the consultant formally approves
discharge and ends with the patient leaving the clinical unit. The admission and
discharge processes can act as bottlenecks in many of the hospital and thus,
adversely affects the efficiency of the hospital. It is a very important indicator of
quality of care and patient satisfaction.

Delay is patient discharge of the patient also increases the pressure on beds of
the hospital delay in discharge is bad for both hospitals and the patients. It
increases cost to the hospitals and is depressing to the patients. Delayed
discharge also increases the patient’s exposure to hospital acquired infections.
So, effective strategies must be in place to solve this issue. National Accreditation
Board for Hospital and Health Care Organizations has set a standard of 180
minutes for the completion of the discharge process. Fortis hospital Gurugram
has set a bench mark of 90 minutes for the total time taken for the discharge.

Time taken for the completion of discharge process is an important indicator of

quality of care. As per NABH, the time taken for completion of the discharge
process should not exceed 180 minutes. Discharge process is the last stage of the
patient journey in the hospital and is more likely to be remembered by the
patient. So delay in the discharge process can be depressing to the patients and
also increases the pressure on hospital beds. Discharge patients from the hospital
are a complex process that is fought with challenges and involves over 35 million
hospital discharges annually in the United States.

The cost of unplanned readmissions has the potential to profoundly improve

both the quality of life for patients and the financial wellbeing of health care
systems. Researchers in the field of transitions of care evaluate the effectiveness
of various approaches to improve the discharge process. One classification
scheme to categorize these interventions is to consider them as: pre-discharge
interventions (patient education, discharge planning, medication reconciliation
scheduling a follow-up appointment); post-discharge interventions (follow up
phone call, communication with ambulatory provider, home visits); and bridging
interventions (transitions coaches, patient-cantered discharge instruction, clinical
continuity between inpatient and outpatient setting).

Appropriateness For Discharge The medical necessity of continued

hospitalization is primarily determined by the presence of an acute health
condition of sufficient severity that on-going diagnostic or therapeutic
intervention, or careful monitoring, is required. However, patients often
appropriately remain in the hospital when these criteria are not met, due to the
lack of a suitable alternative setting to providing necessary care or other social
factors. Premature discharge or discharge to an environment that is not capable
of meeting of patient’s medical needs may result in hospital readmission.

In addition, early hospital discharge may not lead to overall cost-savings if it

results in the need for more intense subsequent health care utilization, including
emergency department or nursing facility visits, as indicated by one observational
study comparing patients who received hospital care from a primary care
physician with care by a hospitalist. REVIEW OF LITERATURE REVIEW OF
LITERATURE A review of the literature indicates that a hospital often discharges
patients with insufficient planning, poor instruction, inadequate information, lack
0f coordination among members of the health care team, and poor
communication between the hospital and community.

A hospital’s professional staff have had a long standing commitment to meet the
needs of hospitalized patients discharged into the community, both to enhance a
smooth transition from hospital to home or other chronic care unit and to ensure
that the patient will function at an optimal level. Discharge planning was
developed, and has always been viewed as a major way to improve the quality of
care and solve the post discharge care problems. Discharge planning Discharge
planning is an interdisciplinary approach to community of care; it is a process that
includes identification, assessment, goal setting, planning, implementation,
coordination, and evaluation and is the quality link between hospitals, community
based services, nongovernment organizations, and carers. Development of
discharge planning Promotion of discharge planning began in the United State in
1960s.

In 1983, Joint Commission on Accreditation of Hospital, and in 1984, American

Hospital Association stated that discharge planning is required and should be
provided to all patients according to guidelines of Joint Commission on
Accreditation of Health Care Organizations. It is viewed as the main method of
ensuring that patient’s post discharge needs will be met to enable them to
function at optimal levels after they return home. In 1983, Marcia Abramson
presents a model for identifying , clarifying and analysing the ethical dilemmas
inherent in the discharge planning process.

In 1988, dubbler discussed about the aim of discharge planning to deal with the
ethical issues and to avoid coerced placement of the elderly in long term care
units. With the evolution of the structure and process of discharge planning
programs, in 1994, the critique concludes with an exploration of ethical issues
and challenges arising from increased emphasis on cost-effective discharge
planning. These include patients’ rights provision of sufficient human, social, and
financial resources; improved hospital-community communications; and control
over hospital-developed but community-implemented programs.

In 1998, discharge planning became an important nursing intervention and

formed part of the foundation of case management practice of managed care.
Purpose of discharge planning Based on the individual needs of the patient,
effective discharge planning supports the continuity of health care between the
health care setting and the community; it is described as ‘the critical link between
treatment received in hospital by the patient, and post-discharge care provided
in the community.’ The purpose of discharge planning is to ensure continuity of
quality care between the hospital and the community.

In addition, the aim of discharge planning is to reduce hospital length of stay and
unplanned readmission to hospital, as well as to improve the coordination of
services following discharge from hospital. Process of discharge planning The
process of discharge planning includes the following : Early identification and
assessment of patients requiring assistance with planning for discharge;
Collaborating with the patients, family and healthcare team to facilitate planning
for discharge; Recommending options for the continuing care of the patient and
reffering to accommodations, programs, or services that meet the patient’s meet
the patient’s needs and preferences; Liasing with community agencies and care
facilities to promote patient access and to address gaps in services; and Providing
support and encouragement to patients and families during stages of assessment
from the hospital.

Discharge planner What is a discharge planner (continuing care coordinator)? A

discharge planner or continuing care coordinator is a person who functions as a
consultant for the discharge planning process within a health facility providing
education and support to hospital staff in the development and implementation
of discharge plans. Discharge planners are assigned to plan, coordinate, and
monitor the process of discharge and to implement discharge policy to assure
continuity of care. They coordinate with the patient, family, health-care team,
resources, and services to facilitate the transition of the patient from hospital to
community or to another care agency in an individualized, time saving, cost
effective, and continuous manner.

Who will be a discharge planner? The discharge planner may be one of the
following persons Social worker; A nurse, the patient’s primary nurse, the nurse in
charge of the unit, the hospital liaison nurse, a “super” nurse (clinical care
coordinator), or a registered nurse located within the social work department;
Inpatient unit’s nurses and attending physicians; A nurse and social worker; The
case manager. In 1985, Mckeehan suggested that a hospital-based organization
such as an interdisciplinary committee of staff members designated to plan
discharge is needed.

When it has been determined that a patient is medically ready for discharge, the
health care team must determine the most appropriate setting for onging care.
Determinants of the appropriate site of care involve medical, functional, and
social aspects of the patient’s illness. The patient’s acute and chronic medical
conditions, potential for rehabilitation and decision-making capacity must be
taken in account. Input is needed from multiple sources to determine the most
suitable discharge plan. Involved parties often will include the patient, family,
case manager, nurse, physician, physical and occupational therapist, social
worker, and insurer.
In order for the patient to be deemed safe and ready for discharge to home or to
a non-acute environment (rehabilitative, transitional, or chronic care), a provider
must take into account a number of factors beyond the medical determinants.
These factors include: Patient cognitive status Patient activity level and functional
status The nature of the patient’s current home and suitability for the patient’s
conditions Availability of family or companion support Ability to obtain
medication and services Availability of transportation from hospital to home and
for follow-up visits. Availability of services in the community to assist the patient
with ongoing care.

Discharge home- approximately three quarters of hospitalized patients are able

to return to their home environment following discharge. For discharge home,
patients with help from family or other caregivers if available should be able to:
Obtain and self-administer medications. Perform self-care activities. Eat an
appropriate diet or otherwise manage nutritional needs. Follow up with
designated providers. Specific insurance benefits and availability of services in the
community may also influence whether or not the patient may be safety
discharged home.

Home services, such as visiting nurses or infusion providers to administer

intravenous infusions, may allow selected patients, who would otherwise need
non-acute residential care, to manage their care needs at home. Discharge to
another care facility- if discharge to the outpatient setting is not appropriate, the
team must then arrange transfer to another inpatient facility for ongoing care.
Determining the most appropriate inpatient setting of care for ongoing
treatment involves determining the patient’s needs and matching needs with the
capabilities of potential site of care.

One model to help accomplish this involves assessing a set of parameters that
describe generic clinical characteristic that are largely independent of the
patient’s specific diagnosis. These needs are then matched with the services
offered at different types of facility. Once it is decided that discharge to an
alternate facility is necessary,, referrals are made to facilities that are felt to be
potentially appropriate, and the patient is screened for acceptance.

The patient must consent to transfer to an accepting facility; if the patient or

family declines, the negotiation ensures to find an acceptable discharge
placement. Types of care facilities- the severity of functional impairments and the
need for assistance with activities of daily living (ADLs) often determine whether a
potential can be safely managed at home or requires care at a skilled nursing
facility (SNF) or extended care facility (ECF). In making this determination,
particular attention is paid to need for supervision in ADLs and safety awareness.

Madicare in the United States identifies three categories of health facilities: Acute
care hospitals Exempt hospitals (inpatients rehabilitation hospitals [IRF] and long
term acute care hospitals [LTACs] Nursing facilities (SNFs and ECFs) Inpatient
rehabilitation facilities- To meet certification criteria. IRFs must admit 75 % of
patients for 1 to 13 specified diagnosis such as stroke or major trauma. Patient
must require multidisciplinary therapy (eg physical therapy, occupational therapy,
speech therapy, orthotic or prosthetic services.) and be able to participate in
intensive treatment. Physician supervision is provided at least three days per
week.

The patient’s stay at the IRF may continue as long as there is continued progress
and the ability to participate in and benefit from at least three hours of therapy
per day. Long term acute care hospitals- LTACs must obtain an average length of
stay > 25 days and patients must require daily monitoring and complex medical
interventions.

INTERNET SOURCES:
------------------------------------------------------------------------------------------
-
1% - https://iqac.subharti.org/pdf/26-11-2018.pdf
1% - https://www.coursehero.com/file/38523871/11docx/
1% - https://www.thegreatapps.com/apps/escape-puzzle-hospital-rooms
10% - http://www.iraj.in/journal/journal_file/journal_pdf/14-308-14800658764-
8.pdf
<1% - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088388/
2% - https://www.slideshare.net/syedimran5494/discharge-time-final
<1% - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450689/
2% - https://www.encyclopedia.com/medicine/encyclopedias-almanacs-
transcripts-and-maps/discharge-hospital-0
1% - https://www.slideshare.net/deepaklost/gap-analysis-of-nabh-3rd-and-4th-
edition
1% - https://www.coursehero.com/file/por4rra/individuals-included-in-the-
patients-daily-activities-that-ensures-they-have-a/
1% - https://www.slideshare.net/MonikaMishra15/readmit-historical-using-sas-
visual-analytics
19% - https://www.uptodate.com/contents/hospital-discharge-and-readmission
4% - https://www.uptodate.com/contents/2790
4% - https://www.uptodate.com/contents/hospital-discharge-and-
readmission/print
18% - https://www.sciencedirect.com/science/article/pii/S1873959812000695
3% -
https://www.researchgate.net/publication/257704376_Discharge_Planning/fulltext
/58f5915d0f7e9b6f82e8ca67/257704376_Discharge_Planning.pdf
1% - https://www.researchgate.net/publication/257704376_Discharge_Planning
<1% - https://www.linkedin.com/in/christi-anderson-780525bb
1% - http://dischargeplanning.org.au/8-pages/1-home
5% - https://www.uptodate.com/contents/hospital-discharge-and-readmission#!
1% - http://www.uptodate.com/contents/hospital-discharge-and-readmission