Hospitals in pursuit of excellence

Discharge Planning on Admission

At Columbia St. Mary's Hospital, Milwaukee, discharge planning truly begins at admission. Care teams of clinicians, case managers, social workers and other staff work with patients and families to set a targeted discharge date and time. The teams participate in coordinated care rounds that "are not the same thing as shift or change reporting," says Heidi Ziemendorf, director of patient services. These structured rounds focus on preparing patients mentally and physically for discharge. White boards in patient rooms record patients' goals, such as walking the halls, and their questions for the physician. Patients also are called during their stay, and feedback is shared with units for follow-up. Brian Hirano, M.D., medical director hospitalist services, says the entire process means "being more thoughtful about discharge." Results include a decrease in patients' length of stay?while readmission rates hold steady?and higher scores on patient satisfaction surveys.