Eliminating Discharge Delay in Hospital in Hospitals PDSA Model

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EliminatingDischarge Delay in Hospital in Hospitals: PDSA Model

Providinghigh quality and sustainable health care requires identification ofinnovative models, systems, interventions and making informed choiceson the degree of applicability of established change (HQIP, 2015). Itis possible to significantly reduce or manage delays in discharges ifthe entire stakeholders in the health care sectors are involved inmaking necessary changes. Centralized cares, coordinating care,liaison between health specialists and nurses, communications andadequate follow-up have been found to reduce delays in discharges(Graban, 2016). However, the approach will be highly successful if itis done in a team such that it is multifaceted and multidisciplinary.Change implemented in the health care sector ought to be sustainablein that it reflects the needs of patients for it to be supported. Ifthe change fails such a test is outlawed, and the team has to lookfor the more appropriate approach (Gregory, 2015). This needunderscores the need for an efficient model that can be used to notonly test but accelerating quality enhancement. This study willreview the application of Plan-Do-Study-Act (PDSA) cycle to evaluatechanges that are made to reduce delays in discharge and lessen theduration of stay in hospitals.


Delayeddischarge and prolonged length of stay in hospitals are a recurrentproblem that leads to excessive costs and augmented rates ofcomplications among the patients (Barach et al., 2015). Some of theleading causes of delays and extended length of stay includefinancial issues, the delayed decision regarding funding from socialservice, family delays, coordination disputes by hospital staff,bureaucratic clearance system and hospital requirement of dischargeconsent among others (Gregory, 2015). Correspondingly, dischargedelays have various consequences such as operational inefficiency,increased the cost of the treatment process and the loss ofreputation by the health institution where the patient was admitted.Some of the solutions that have been raised to eliminate thesechallenges include effective patient planning and automatinginstitution procedures.

PDSAmodel is a simple but valuable model used for testing andaccelerating quality enhancement (Graban, 2016). When the researchteam sets the objectives, institute the participant`s membership anddevelop interventions to determine the possibility of change leadingto improvement, Plan-Do-Study-Act is put into use to examine thechange in real life situation. PDSA comprises of planning, trying,observing outcomes and acting on these findings (HQIP, 2015). Themodel is significant in that it enable the medical team to plansufficiently for their selected innovation meant to improve servicedelivery in health care. The model allows the health care team torectify their novel innovation until the approval rate reaches ninetypercent because testing is done locally and in small scale (Spath,2013). Moreover, it develops confidence build up because theinvention has been tested to ensure that significant resources arenot invested into unworkable change.


Planningrequires hospital department inaugurate a team constituting ofdischarge coordinators consisting of physicians and nurses to observeand monitor the patients from the moment they are admitted. Theseteams will be responsible for calculating the approximate date ofdischarge and coming up with suitable arrangements before the actualdate of discharge to allow appropriate transition (Barach et al.,2015). The team will also make the necessary arrangements tofacilitate transport for the patients to ensure that unexpectedprocesses do not hinder the process. The reason for the anticipatedoutcome is to have the patient’s expected timeline for dischargereduced. Practical agreements will also be made on the actual datathat will be collected during the process as well as the individualinvolved in the collection (Gregory, 2015). The required time frameof the entire process will also be agreed because the successes ofthe whole process depend on effective planning.


Theteam of nurses and physicians will be positioned for respectiveplaces such as reception, pharmacy, surgical wards and other relevantareas (HQIP, 2015). The patients are prepared appropriately such thatthey can quickly move from one serving point to the other.Adjustments are implemented, accurate measurements are carried out,and all the required data is collected for analysis (Graban, 2016).It is significant to allocate adequate time to the activities in thisstage especially if there are more than a single change that had beencarried out. The team will liaise with discharging nurses to lay outthe plan for interdepartmental communication systems regardingdischarge procedures and practices and the necessary notificationsystems as required by the institution and recommended by Gregory(2015). Care should be taken such that all the patients acquire thenecessary instructions and that they provide all the requiredinformation. For instance, contact details are significant becausethey will be required to give feedback on the service offered and theview on the significance of the changes that has been instituted.


Theinformation gathered will be subjected to complete scrutiny, andappropriate comparisons will be made between this process and otheractivities that are taking place in the institution which are notrelated to the real change (Spath, 2013). Patients’ feedback andother relevant information are obtained and analyzed. The informationwill be essential in the decision-making process because patients arethe primary beneficiaries of the change being implemented. This stageconstitutes comprehensive studies and precise analysis of the entireprocess to establish the most relevant facts that have been learnedfrom the change that has been implemented (Feigal et al., 2014). Theinformation that has been collected from this stage is significantbecause it is used to determine the level success or failure of theentire process. In this juncture, the team gathers together, and eachgives an account of their experiences that they have collected fromthe process.


Actingis one of the most significant stages in the process of acceleratingquality enhancement because critical decisions are made at this stage(Barach et al., 2015). The change can either be adopted or rejected.Upon rejection, more original arrangements to come up with somethingnew altogether are made. Ninety percent of all the participants inthis process must give consent for the process to be consideredviable. This decision is so significant that it is used by theinstitution decision making the body to establish the viability andpracticability of the change process. Nurses, physician, anddepartmental leaders are not restricted by the change and especiallyif it is not viable (Feigal et al., 2014). Consequently, they are atliberty to adopt other practicable modifications and innovations aslong term goals, because they are at the center of decision-making asfar as the provision of quality and affordable health care isconcerned.


Delayeddischarge and prolonged length of stay in hospitals are a recurrentproblem that leads to excessive costs and augmented rates ofcomplications among the patients. Changes in health care aresignificant to ensure that services provided match the needs of thecontemporary issues in health care. Changes implemented in the healthcare sector ought to be sustainable in that it reflects the needs ofthe patient for it to be supported. Accordingly, there is the needfor an efficient model that can be used to not only test butaccelerate quality enhancement. Plan-Do-Study-Act (PDSA) cycle can beused to verify the viability of changes meant to eradicate delays indischarge and reduce the length of stay in hospitals. The modelentails four steps that include planning, doing, studying and acting.


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Feigal,J., Park, B., Bramante, C., Nordgaard, C., Menk, J., &amp Song, J.(2014). Homelessnessand discharge delays from an urban safety net hospital.Public Health, 128(11), 1033-1035.

Graban,M. (2016). Leanhospitals: Improving quality, patient safety, and employeeengagement.CRC press.

Gregory,J. (2015). Stafffaces conflicting pressures as they deal with discharge delays.Nursing Standard,29(26), 9-9. http://dx.doi.org/10.7748/ns.29.26.9.s7

HealthcareQuality Improvement Partnership (HQIP). (2015). AGuide to Quality Improvement Methods.Healthcare Quality Improvement Partnership Publishers.

Spath,P. (2013). Introductionto healthcare quality management(2nd ed.). Chicago, IL: Health Administration Press.