Case Studies

Team Care Discharge Process Streamlines Disposition, Expands ED Capacity

Saddleback Memorial Medical Center - Laguna Hills

Hospital Beds 252
Annual ED Visits 36000
ED Beds 32
Fast FactLevel II Trauma Center

Team Care is a philosophy of collaborative care delivered at the bedside that has been used by hospitals across the country to improve emergency department (ED) throughput and disposition. Here we discuss Team Discharge, a process in which physicians and nurses work together to free up beds and get patients home faster.

Saddleback Memorial Medical Center in Laguna Hills, Calif., is a committed lean organization that strives to eliminate waste and add value for its patients. As part of its continuous improvement cycle, the ED team applied lean principles to boost throughput and speed disposition of the 36,000 patients it cares for annually. Their innovations in this area evolved into Team Discharge, a process in which team members contribute to disposition planning in an anticipatory fashion.

Team Discharge actually begins with arrival. The provider performs an initial assessment and decides whether or not the patient is likely to be discharged. If yes, the triage nurse and administrative staff coordinate a ride home, and team members use a communication system to track progress of the care plan. At discharge, the physician and nurse meet with the patient together to provide education, go over discharge instructions, and answer any remaining questions.

Team Discharge at Saddleback–Laguna Hills eliminates many common roadblocks that keep patients lingering in the ED. Physicians print their own paperwork, which streamlines the correction and approval process. If the patient’s primary nurse is busy, any available RN can join the discharge meeting.

Project champions Khanh Tran, MD, Assistant ED Medical Director, and Karen Sharp, RN, ED Nurse Manager, say the toughest part of implementing Team Discharge was convincing busy physicians that the process would actually save time. To accomplish this, they pointed to data showing that 90 percent of patients have discharge questions. In the past, the nurse would interrupt the meeting to relay the question to a physician. By contrast, Team Discharge provides immediate answers, freeing the bed for the next patient.

Seven months after the launch of Team Discharge, turnaround time to discharge (TAT-D) at Saddleback–Laguna Hills had decreased by 22 percent.

"After an ED visit, there are often complex problems to be solved before the patient can safely head home. Team Discharge gives us the opportunity to get insights and help from everyone involved."
Khanh Tran, MD
Asst. ED Medical Director
Saddleback Memorial Medical Center - Laguna Hills

Staff evaluations of the program have been favorable. Nurses are pleased that they no longer need to act as a go-between for the physician and patient. Team members also feel the extra support and backup they receive reduces stress and improves patient care. “Team Discharge gives you the opportunity to get insights and help from everyone involved,” Tran says. Team Discharge was so successful at Saddleback–Laguna Hills that CEP America incorporated the process into its Team Care solution.

To learn more about Team Care, download our in-depth white paper.