Physicians
They need to know when discharges are a high priority, and also need to communicate with the patient and family when discharge is pending. They also need to communicate to nurses. Simply entering a discharge order is not an effective method of communication. It was routine when I would ask about the discharge process in various hospitals that I would be told by physicians that they did an awesome job of writing discharge orders before noon. Then I would have a discussion with the nursing staff who said they had no idea when a discharge order had been written and received no verbal communication from the provider. I referred to it as a secret discharge.
Secretaries
They must remove patients from the census in a timely fashion and immediately communicate with bed-assignment and environmental services. This may involve coverage for breaks and lunch, etc.
Nurses
They need to know if decisions are being made which will affect environmental services staffing, such as intra-unit transfers or patients going for testing for example.
Bed-Assignment
They need to know if there is sufficient staffing to manage the demand of multiple admissions coming from various areas with different needs during peak demand times.
Environmental Services
Must assign sufficient staffing to meet the demand of bed cleans. Newer cleaning methodologies have resulted in longer clean times for rooms resulting in extended bed turn-over times. This means that a standard of 30 min per bed clean may now come close to 1 h or longer for what are referred to as “terminal cleans” (Figure 13-3).
Figure 13.3 Example of timing of admissions versus bed available time.
Any given hospital will need to understand how many discharges before noon are required and will need to develop a plan to achieve that objective.
The question of how many discharges before noon is based on a number of factors.
Hospital Occupancy
A hospital with relatively low occupancy and multiple beds available to patients has little need for discharges before noon from a patient flow perspective. However, from a staffing and cost perspective, managing discharges well could have a major impact. How many hospitals can afford to maintain a significant number of empty beds to deal with the natural and artificial variability created by the ED, OR, and Cath labs? Staffing up and down for various scenarios can be challenging to say the least. The primary use of hospital capacity management is to manage the demand/capacity needs of the hospital at the lowest cost and the highest efficiency and most significant value to the patient. This requires even small, lower occupancy hospitals to be good at capacity management.
