#12 - Discharge Barriers Tile

Jeff Terry: Hello and welcome. This is Jeff Terry. I'll be joined by my good friend Andy Day.

We're here to talk about the Discharge Barriers Tile, or what's sometimes called the Discharge Tasks Tile. It's in use at 17 hospitals in the US, Canada and the UK. Andy, before we dive into the details, could we start by explaining the purpose of the Tile or what problem it helps to solve?

Andy Day:

Sure. The Discharge Task Tile or Discharge Barriers Tile really helps to focus on patients that are supposed to go home today, tomorrow, and what tasks are outstanding for them to be ready to go and successfully discharged on time.

Jeff:

Terrific. And what measurable impact have we seen and should new users expect?

Andy:

A number of our clients have reported a reduction in length of stay or excess days. Also, the service leaders, the folks that actually own the teams that provide these tasks, can better coordinate their work lists by seeing discharge-related tasks that needed to be pulled to the front of their queue. And lastly, for coordinating the freeing up of capacity for the ED or the OR, those urgent - most urgently needed beds, we can go find them and see what's outstanding very quickly and get it to happen.

Jeff:

So some of that we would expect to see both the reduction in excess days and a reduction in waiting in places like the ED and the PACU.

Andy:

Exactly.

Jeff:

Wonderful. Well, I see we have Tile Viewer up, so maybe before we get too far into details, could you orient us to Tile Viewer and then the basics of how the Tile works? Andy: Happy to. So what you see on the left hand side of our screen right now is the Tile Viewer launchpad. And we use this when you log into the Wall of Analytics from your laptop or your iPad or however you're accessing it, to select the Tile you want to look at.

And today we're going to look at Discharge Tasks. So I'll click on that, which will take us to the Tile itself. And so before we dive into the details of the Tile, I'm going to look, orient you to the navigation of it. If you go to the top, look at the top bar, you see the name of the Tile going across to the right. You see the ‘i’ or the Info button, where we have the legend, which we'll just show you quickly.

And then also to the right of that, you have the gear button or the Settings, which I'll show you quickly. We'll navigate into those in more detail to illustrate how they work in a few moments. Then in the very bottom, the lower left corner, the little flickering back and forth, that indicates the freshness of the Tile, when it was last updated. So we can make sure that it is refreshing on time.

And then the 1, 2, 3 across the bottom are pages of alerts that are shown above. And it paginates like the Hertz board at the airport. And you can control that in the settings button and change its duration, or turn it on and off if you so choose.

Jeff:

Wonderful. Very clear, thank you. Yeah, please, continue.

Andy:

Sure. So that each of the items that you're seeing here, each of these rows is a patient, and the patient is either supposed to go home today or tomorrow. That's a configurable setting that the clients can adjust. And so you see, as you look at each row, the patient's pseudonym and their identifier number. And I should mention, of course, all this is de-identified. This is not actual patient names or identifiers, obviously for demonstration purposes. what bed number they're in, and then what tasks are outstanding for that. And you see, in this case, there's no outstanding tasks. So this patient's ready to go.

Then all the way over to the right, you see is that patient a confirmed discharge or a potential discharge? And of course, that's sorted by that. And then under the tasks, there are many different tasks and let me just show you some of those. So if I hover over the x-ray one right there, you'll see under that patient, they're waiting for a chest x-ray before they can go. And then if you go, we'll go to the left of that. They're also waiting for a CT of the abdomen and pelvis. So those two are outstanding. So if I'm the radiology service manager and I can look at this list and say, "Ooh, I better get those two done, they're going to hold up a discharge if I don't get them going quickly." And to do that, let's go to the gear button, the Settings button, and apply a filter.

So let's say I am that radiology manager. So I'm going to go to the tasks filter and select for ones that are radiology related, the maybe MRI and x-ray and CT. Pick several of them. And so now it's filtered down the list to only those patients that have a radiology-related discharge task that's outstanding. It'll still show the other tasks that the patient also has, because sometimes you need to know that, because there's an order in which they need to be performed or one might block the other. But you can filter this. And now if I'm the radiology manager, I can prioritize this in my work list.

Another common user of this Tile is a unit manager. So I can go back and clear that filter and go up to the gear again and say, okay, “I'm going to select the units or wards that I own”. So I'm going to pick one or two here that I'm the owner of and hit apply. And now you see that just patients that are in my ward, what are their discharge tasks? And as an example, the little barbell means physical therapy. The little pill is tracking the meds to beds or drugs to go home with process step, and we'll click on that. And you'll see that this is in step number 1 of the process, which is the ordering process. And then below that, again, some more of a CT and whatnot.

So again, these tasks are chosen when we set up the Tile with the client to be the tasks that have been shown to be the biggest source of delay in the discharge process.

Jeff:

Andy, let me ask two quick questions - come to mind. One, the data for this, where we're not asking people to enter things to feed this Tile, so where does the data come from?

Andy:

Yeah, absolutely right. One of our organizing principles is, is that there's already a heavy documentation load on frontline care providers. You don't do any documentation in this Tile. This Tile gets data from the existing patient medical record and other systems. So it looks in the module for radiology and it looks in the orders and it looks in the, you know, a variety of different places within the EMR and outside the EMR to pull the data elements it needs so that they can be presented to the users on the Tile.

So it's clear what tasks are outstanding without having to hunt around patient by patient, looking through their work list.

Jeff:

Got it. And we're seeing this on a PC. It can also be used on devices. Can you talk about where I can access this?

Andy:

Sure, sure. I mean, the client ultimately controls who has access through active directory, but they, through that process, they can give access to the appropriate clinicians, whether it be on a laptop or a desktop. You can also access it on tablets or even mobile phones as they're walking around the hospital. And then lastly, they can also use the Tile in the Command Center up on the big board, up on the wall, to focus on those beds that need to be empty today, so we can decongest the ED or other critical areas.

One last thing I'd also mention is that there's a flags column all the way on the left. An example of one of those flags is the little map pin down there. And that is identifying that this patient, if you will click on it, is coming from a postal codes outside our catchment area. So it's, a transport is going to be more difficult to arrange for this patient because they have to go further. And there are other flags like this, and those are selected together with the client at the time we set up the title.

Jeff:

Terrific. So patient by patient in the rows, under the tasks are the specific barriers for that patient, and then this left-most bar is calling out, not barriers necessarily, but other items of interest, to be sure we manage.

Andy:

Correct. Some clients use it for like, ‘This patient's going to go to the discharge lounge, or is a candidate for the discharge lounge’. Some use it for other things. It's just client by client, depends on what the need is.

Jeff:

Wonderful. Well, that's very clear, Andy. Anything else you want to add before we wrap?

Andy:

This Tile has been used by a number of clients in a number of different countries with great success. And again, I think the most important thing is it helps to pull work list items to the top of the queue for those patients that, where that space is needed the most.

Jeff:

Wonderful. Thank you, Andy. And thank you all for joining our webinar today.

Jill Clayton:

I'm Jill Clayton. I’m a senior matron at Bradford Teaching Hospitals, and historically, I’ve looked after the elderly care department, but I’m currently looking after the Oncology Hematology Department. That’s across multiple services, really. So you have what we refer to as the clinical site team in Bradford. You’ve go the nursing staff on the ward. You’ve go the pharmacy coordinators. You have the therapy team leaders, both physio and occupational therapy.

You have the radiology scheduler. And you’ve got the complex discharge team, which in Bradford we refer to as the MAID team. It’s a Tile that allows everybody across the organization a very quick overview of patients that we have identified as having an expected discharge date of today and the things then that may be preventing that person from going.

So you can prioritize scans. Or you can prioritize therapy. Or you can prioritize take homes. What are the elements that are stopping that person from being discharged from the hospital today? And because it pulls information out of our electronic notes system, it’s very quick and easy to look at it and get an overview. And instead of people having to ring the ward to identify ‘What are the elements?’ it can very quickly see at a glance, ‘What are those things that my department or my colleagues need to be dealing with to move this person through the system and discharge them in a more timely manner than we have done previously?’

I think the main benefit is speeding up the discharge process, because it allows everybody that works in the hospital to prioritize any barriers that they are responsible for helping with. So obviously, the whole idea is to try and get patients out of hospital at the earliest opportunity. And, you know, from an elderly care perspective, we try and have a bit of a mantra of ‘home for lunch’, because the earlier someone goes home, the more likely it is to be a successful discharge. And that obviously means then that your capacity for the next patient is created much earlier in the day, and you don’t come into blocks around teatime.

So what this does is, it allows us to identify who wasn’t identified and get a discharge of today and what are those elements that are preventing that person from going home now. The benefits of the Tile are really a quick, at-a-glance overview of every patient, identified on your ward, with expected date of discharge today to look at what are the things that you need to help happen to get them moved and onto the next step in their journey.

Terri Saunderson:

My name's Terri Saunderson. I’m Director of Operations for Unplanned Care, and part of my role I suppose, is the overall management in the Command Centre and operational flow across the whole hospital. That was the last bit of the jigsaw for all the interns to be able to get the numbers right.

So I think yes, incredibly helpful, but we didn’t have it for as long a time as we’d hoped before we hit this (Covid-19). And then it wasn’t quite as useful because we were emptying beds left, right and center for different reasons. But up until then, yes, I think that was the final bit of the jigsaw that made us use patient placement a bit better, because you could actually see it.

But again, I think the key thing for everybody in all of this is, it’s EDD’s and the PDD’s that really drive all of it. And that massively has to be the focus I think, to make that work as well as it could do. Because we were using it, but because people weren’t necessarily putting the information in, it wasn’t quite - things weren’t quite validating, but at least we had something to start thinking about. To go back and challenge people on, whereas previous, you just kind of waited and at 5 o’clock you go and ask yourself well that will do or it won’t. But even when the number was wrong, we then could go back and go ‘Well hang on a minute. How come you didn’t know about these patients going at 9 o’clock? At 5 o’clock? You must have known.’

So they should have put them on and then we could have been able to see ‘So you’re not doing the discharge tasks properly’. So that’s the benefit, I think, is being able to go and challenge people. And so yea, I think that would be an integral part of what we need going forward. And it’s not necessarily even challenging things, it’s about understanding why they don’t realize how important it is for themselves more than anything else. And the more that you do that, the more people realize the benefits of using it, it’s not seen as something to be worried about or an extra job. And I think that’s where people are seeing it at the beginning. It actually takes away something. If you get that right, we’re not coming to you at 9 o’clock saying, “Hang on a minute, what on earth’s going on here?” because we know what’s going on because you’ve told us.

So I think that’s the benefit of that particular Tile, to be honest.