Bed Management and Discharge

Processes at the MSMC

Internship Report
April 8 July 4, 2014
Brendan Drew, B.S.
M.Sc. Healthcare Policy, Innovation and Management Programme
Maastricht University
Project 1: Bed Allocation by Clinical
Department
Goal: Allocate a fixed number of beds to each clinical department
Rationale:
Facilitate admission and bed allocation processes
Facilitate nursing specialization
Aggregated data from 6 months of
inpatient admissions reports
Calculated average (with std
deviation), maximum and
minimum daily bed use by clinical
department
Calculated the number of general,
private and semi-private beds to
be allocated to each department
Project 1 Conclusion
Variability was too
great to allow for fixed
bed allocation
Medical
superintendent
advised against
proceeding with
project
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Days
Neuro Surgery Department Bed Use
Project 2: Mapping the Discharge Process
Collaborated with NH interns to map the discharge process, focusing
on identifying non-value-added steps
Conducted on-the-floor observations and interviews with staff
Developed ideal process flows for cash, corporate, scheme and ESI
patients
Proposed IT and non-IT solutions to address identified inefficiencies
Project 2: Discharge Summary Preparation
Discharge summary was
consistently identified as
a bottleneck (only 8%
completed in under 40
min.)
Developed an ideal
process flow that
improves coordination by
use of SMS and email
communication
ADVISE DISCHARGE ONE DAY PRIOR
RESIDENT DOCTOR WRITES COURSE IN HOSPITAL
ON A DISTINCT SHEET WITH CORRECT DIAGNOSIS,
CORRECTED HISTORY & MEDICATION ADVICE (WITHN 2 HRS)
FILE SENT TO DISCHARGE DEPARTMENT
(WITH 30 MIN.)
DRAFT OF DISCHARGE MAILED TO RES. DR.
/ ADMITTING CONSULTANT
MAKES CHANGES (IF ANY)
INV. ON DISCHARGE
SAMPLES SENT EARLY MORNING
(DAY OF DISCHARGE)
SAMPLES PROCESSED
WITHIN TAT
REPORTS GENERATED
& AUTHENTICATED
PRINT TAKEN AT WARD
IF CHANGES BY RESIDENT,
SEND TO ADMITTING CONSULTANT
FOR FINAL APPROVAL
IF CHANGES MAILED BY
ADMITTING CONSULTANT,
TREAT AS FINAL APPROVAL
APPROVAL BY
ADMITTING CONSULTANT
GENERATE PDF
WITH DIGITAL SIGNATURE
UPLOAD FINAL DISCHARGE SUMMARY TO HINAI
Project 2: Key Proposals for Discharge
Summary Preparation
Patients should be advised for discharge tomorrow and have the
necessary investigative reports ordered in advance whenever possible
Doctors may dictate the discharge summary to a central phone line
Discharge summary drafts should be emailed to junior and senior
doctors (SMS alerts may be used for doctors without smart phones)
Doctors authorize the final draft of the discharge summary with a
digital signature which generates a pdf of the final draft
Project 3: Preparation of Masters Thesis
Analyzed data from 1,000 hospital discharges in the month of January
2014
Research Question: How does financing method (cash, corporate, ESI,
or scheme) affect the discharge turnaround time?
Methodology: Multiple linear regression analysis
Confounding Variables: Gender, length of stay, admission category,
time of day of advised for discharge, ward location, and clinical
department
Project 3: Results
Independent
Variable
Regression
Coefficient
Std. Error t P
Reference 557 29 19 <0.001
Corporate 20 20 1.0 0.337
ESI -16 17 1.0 0.337
Scheme -68 27 -2.5 0.011
Gender 7 15 0.5 0.651
Procedure 3 20 0.1 0.893
Surgery -13 21 -0.6 0.523
Project 3: Conclusion
Discharge turnaround time is shorter for scheme patients relative to
cash patients
There is no statistically significant difference in the turnaround time
for corporate and ESI patients relative to cash patients
Statistically significant predictors of discharge turnaround time:
Time of day of discharge
Ward allocation
Project 3: Writing the Paper
Theoretical basis: As the health insurance market develops rapidly in India,
it is important to understand the administrative burden placed on hospitals
by third-party payers
Hypothesis of this study was that administrative burden would lead to an
increase in time spent on hospital processes such as discharges proven
incorrect
Included process maps as a more qualitative analysis of the impact of
financing method on discharge processes
Directions for future research:
Quantify administrative burden of use of third-party payers in other terms (e.g.
monetary costs, man-hours spent)
Implement streamlined and standardized billing processes and analyze impact on
hospital billing and insurance-related costs
General Observations on the Internship
Overall very positive experience
Would have been nice to have more time prior to my arrival to
develop the topic
Conflicting expectations of academic supervisor and management
Need to meet managements expectations while using the scientific method
and demonstrating aptitude in data collection and analysis
Short time period limits possibilities, especially for testing
implementation of a new process/protocol
Thank you!
For the hospitality you have shown and the opportunity you have given
me to learn from your institution. It has been a privilege to work with
such dedicated professionals. I can think of many instances of members
of the NH staff at all levels going out of their way to be helpful and
welcoming.