UCLA Inpatient Geriatrics Unit in the news!

Left to right: Luela Ramos, N.P., Chinette Salveron, AN II, Rose Sharpley, R.N., Sonja Rosen M.D., Patrick O’Hare, ACCP and Valerie Yeo, Unit Director.

Lean Transformation Improves Discharges, Communication in Inpatient Geriatrics Unit

Discharging patients from the hospital is a complex process that may be particularly challenging when dealing with elderly patients. In January 2012, the inpatient geriatrics unit at UCLA Medical Center, Santa Monica (SMUCLA) launched an initiative designed to increase efficiency in discharge processes and improve overall communication.

“Our unit frequently operates at or near full capacity, and we are unable to admit new patients if there is no bed available,” says geriatric medicine specialist Sonja Rosen, M.D., medical director, inpatient geriatric unit at UCLA.

According to Dr. Rosen, two key objectives related to improving throughput were established: anticipating who will be discharged the next day with 35 percent or greater accuracy, and writing discharge orders before 10 a.m. in 25 percent or more of cases. Over the last two years, the geriatric unit had surpassed its goal in anticipating discharges by adding discharge planning rounds in the evening and integrating their discharge planning goal into all rounds. However, writing discharge orders before 10 a.m. remained a challenge.

This was a great opportunity for the Lean team to help. The team developed a process map to help visualize the discharge process and the tasks required of each team member to keep the discharge on track. They also assigned the nurse practitioners to take ownership of process, empowered individual team members to make decisions and solve problems as necessary, and focused on improving education and communication among faculty and housestaff.

“A key challenge for us was to communicate better with each other so that our communi-cation with the patient was more unified,” says Chinette Salveron, R.N., assistant nursing unit director of 5NW, the SMUCLA inpatient geriatric unit, and project team lead for the Lean initiative. To improve information sharing, the team developed a patient brochure providing a general outline of what to expect during hospitalization and placed white boards in each patient room to facilitate interactive communication between the hospital staff and the patient’s family.

“We have been able to radically reengineer our communication systems,” says UCLA geriatric medicine specialist Brandon Koretz, M.D., sponsor of the Lean project. “On any given day, everyone on the care team knows exactly what is happening with each patient and is able to communicate the plan to the patient’s family. The consistency has been excellent.”

Brendan Koretz, M.D.