Date of Award
Spring 5-24-2025
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Joseph Burkard, DNSc, CRNA, EBP-C
Abstract
Introduction: University of California San Francisco (UCSF) Saint Mary’s Health, has two hundred forty licensed beds to utilize for patient care, ninety one that can be used for inpatient medical surgical patients. Throughput is a challenging issue, especially at Unit seven west which houses thirty beds. Post op surgical orthopedic patients, medical surgical patients from the emergency department (ED), intensive care unit (ICU), and telemetry downgrades are waiting for inpatient beds, which causes delays in care and increases length of stay.
Background: Unit seven west is a surgical ortho floor with a high admission census consisting of three to ten surgical admissions not including medicine admissions from the emergency department. An internal analysis completed showed that discharges are not happening when a discharge order is placed delaying discharge three to eight hours and length of stay has increased with our orthopedic surgical patients.
Problem: Based on a three month data analysis of discharge orders & actual departure, there is about 82% of patients not leaving the hospital within the expected length of stay of two days, especially orthopedic patients.
Purpose: The purpose of this evidence based practice (EBP) project was to improve hospital throughput which will lead to bed availability in inpatient units. Patients at unit seven west, an acute surgical orthopedic, medical surgical, do not discharge enough patients a day to keep up with the demand. This situation led to an imbalance of bed availability with the need to admit on average 6.5 direct admissions from the Emergency Department.
Vision & Method: The goal was to utilize a streamline service named Unit Based Leadership Team (UBLT) and group, “Why throughput is group-put” to create a solid process in determining barriers to discharge through implementation of an evidence based discharge checklist, multidisciplinary rounds with care coordination, rehab, and physicians can identify early discharge barriers especially with orthopedic patients who have higher discharge rate. The plan for sustainment was to identify the barriers for patients discharging a one percent increase of total patients for each month to discharge within two hours of discharge order placed, with target goal by May 2024 will be 39%. This decreased length of stay, and increased throughput by admitting more patients. A patient’s typical cost for a length of stay was estimated to be three thousand dollars per day. A typical length of stay for an ortho patient was four days, if you decrease that by two days, you decreased the cost of hospitalization by half, or six thousand dollars total!
Success Criteria & Results: The plan for sustainment to discharge orthopedic patients within two hours of discharge order to sustain at a one percent increase of total patients for each month to discharge within two hours of discharge order placed, with target goal by March was 39% and discharged at least one per noon each day.
Clinical Implications: Identifying early discharges improved outcomes for patient care by decreasing length of stay. This prevented quality metrics that would happen with increased length of stay such as hospital acquired pressure injuries (HAPI), catheter acquired urinary tract infections (CAUTI), and falls. This also enabled patients to transfer from ED and ICU within thirty minutes of transfer order.
Conclusions: Having a service line, why throughput is group-put, can provide focus on identifying barriers to throughput, discharges, and setting realistic goals for patients length of stay.
Keywords: Discharge, throughput, orthopedic, medical-surgical, length of stay
Digital USD Citation
Sales, Edward, "Why Throughput Is Group-Put" (2025). Doctor of Nursing Practice Final Manuscripts. 298.
https://digital.sandiego.edu/dnp/298
Copyright
Copyright held by the author
