Discharge Process Synopsis

A Dissertation Synopsis

On

A Study of Discharge Process of Oncology Department with a view to reduce

time
At
International Oncology Cancer Centre, Fortis Hospital, Noida
By
Dr. Bhavya Agarwal

PRN- 13040141013
Under the guidance of

Ms. Neha Bhagatkar
INTRODUCTION
DISCHARGE PROCESS
Discharge from hospital is a process and not an isolated event. It should involve the
development and implementation of a plan to facilitate the transfer of an individual from
hospital to an appropriate setting. The individuals concerned and their attendant(s) should
be involved at all stages and kept fully informed by regular reviews and updates of the care
plan. Planning for hospital discharge is part of an ongoing process that should start prior to
admission for planned admissions, and as soon as possible for all other admissions. This
involves building on, or adding to, any assessments undertaken prior to admission. Local
implementation of the single assessment process (SAP) needs to take account of this critical
issue.
Effective and timely discharge requires the availability of alternative, and appropriate, care
options to ensure that any rehabilitation, recuperation and continuing health and social care
needs are identified and met.
RESEARCH METHODOLOGY
Conduct an observational study.
CHALLENGES
1. Since the discharge process was a big process it was a tedious task to collect the
entire data for the same.
2. The process also involves a lot of departments thus collecting data was a challenge.
FLOW PROCESS OF DISCHARGE OF PATIENTS

Patients chemotherapy finishes
Doctor checks patient for any

complications and medicines are indented
as per prescription
Discharge process initiated by nurse
Activity book containing discharge initiation papers

taken to the billing counter
Patients attendant receives message from billing and

takes the clearance papers to the Day Care for
discharge
GDA comes back to the Day care after giving the

discharge papers to billing
Indented medicines and Instructions given

to Patient and patients attendant
Patient moves out of bed
Bed made ready for next patient
RESULTS
The study carried out was done with a sample size of 100 before the implementation of
recommendations and a sample size of 100 after it. Earlier the average time taken to
discharge a patient was around 113 minutes which was brought down to 83 minutes after
the implementation of few of the suggestions.
OBJECTIVES
1.
2.
3.
4.
To study the process flow of discharge time of Onco Day Care.

Record and analyze the turn around time of the process.
To identify factors which are causing delays in the turnover of bed.
To suggest corrective actions for the delays.
LITERATURE REVIEW
DISCHARGE PROCESS
Discharge from hospital is a process and not an isolated event. It should involve the
development and implementation of a plan to facilitate the transfer of an individual from
hospital to an appropriate setting. The individuals concerned and their attendant(s) should
be involved at all stages and kept fully informed by regular reviews and updates of the care
plan. Planning for hospital discharge is part of an ongoing process that should start prior to
admission for planned admissions, and as soon as possible for all other admissions. This
involves building on, or adding to, any assessments undertaken prior to admission. Local
implementation of the single assessment process (SAP) needs to take account of this critical
issue.
Effective and timely discharge requires the availability of alternative, and appropriate, care
options to ensure that any rehabilitation, recuperation and continuing health and social care
needs are identified and met.
ELEMENTS OF THE DISCHARGE PROCESS
Discharge planning Discharge planning is the development of an individualized discharge
plan for the patient prior to leaving the hospital, to ensure that patients are discharged at
an appropriate time and with provision of adequate post-discharge services. Such planning
is a mandatory part of hospital accreditation.
Discharge planning is a complex process that seeks to determine the appropriate level of
services required by the patient and then match the patient to an appropriate site of care .
This process ideally begins at the start of the hospitalization.
Discharge summary The primary mode of communication between the hospital care
team and aftercare providers is often the discharge summary, raising the importance of
successful transmission of this document in a timely fashion.
Patient instructions At the time of discharge, the patient should be provided with a
document that includes language and literacy-appropriate instructions and patient
education materials to help in successful transition from the hospital.
Discharge checklist Checklists provide an effective mechanism for ensuring that
discharge communications (the discharge summary and direct communication with both
aftercare providers and patients/families) reliably incorporate all key elements.
Discharge Assessment and care plan[4]

A discharge assessment looks at the needs that someone is likely to have when they are
discharged or transferred from hospital. Many people only need a small amount of support
when they leave hospital, but others will need a more comprehensive package of care.
If the person being cared for is likely to have ongoing health and social care needs when
they leave hospital, the assessment may be carried out by a multidisciplinary team of health
or social care professionals. Depending on their needs, the multidisciplinary team could
include a social worker, physiotherapist, occupational therapist, speech therapist, mental
health nurse or dietitian.
The person being cared for should be fully involved in the assessment process, and their
views should be listened to. With their permission, carer should also be kept informed and
given the opportunity to contribute.
If the carer or the person being looked after would like help putting the carers views across,
an advocacy organisation may be able to help
Care plan
The next stage is to draw up a care plan detailing the health and social care support that will
be provided to the person you look after. Again, you should both be fully involved. Views
and concerns should be taken into account, including whether the carer is willing to provide
care when the person being looked after leaves hospital and, if so, how much.
The care plan should include details of:
the treatment and support the person gets when theyre discharged
who will be responsible for providing support, and how to contact them
when, and how often, support will be provided
how the support will be monitored and reviewed
the name of the person who is co-ordinating the care plan
who to contact if theres an emergency or if things dont work as they should
RESEARCH METHODOLOGY
RESEARCH DESIGN
Analysis of the primary data.
DATA SOURCES
Data is collected from the Day Care.
DATA COLLECTION
Primary data has been collected manually.
SAMPLE SIZE
A sample size of 100 before the implementation of suggestions and 100 after the
implementation of suggestions were recorded.
SAMPLE PROCEDURE
Simple random sampling
RESEARCH QUESTION AND HYPOTHESES

1. To test whether there is a significant difference in the initiation of discharge process
by nurse and taking the activity book to billing counter, before and after the
implementation of the suggestions.
Ho There is no significant reduction in time after the implementation of suggestions.
H1 There is significant reduction in time after the implementation of suggestions.

2. To test whether there is a significant difference in the patient moving out of bed
and bed ready for next patient before and after the implementation of the
suggestions.
Ho There is no significant reduction in time after the implementation of suggestions.
H1 There is significant reduction in time after the implementation of suggestions.
SIGNIFICANCE OF THE STUDY

At times the patients planned as per schedule of their chemotherapy cycle exceeds the
number of beds present in the Day Care. During such times there is a necessity of an
effective discharge process to increase the turnover of beds.
LIMITATIONS
1. The study has been carried out only for Oncology day Care. The data is collected by
random sampling.
2. I was a single observer for the study.
3. The time period for the study was limited and thus a check for further improvement
in the process could not be made.
4. Staff was trying to hide their flaws.
5. The implementation of suggestions was done for only two steps i.e.
Time difference between The discharge initiated by the nurse and GDA takes
Activity Book to billing.
Time difference between Bed ready for next patient and patient moves out of
bed.
Chapter Division / Theme of the study

Serial no.
1
2
3
4
5
6
7
8
Chapters
Abstract
Acknowledgement
Introduction
Literature review
Research Methodology
Data Analysis
Findings & Recommendations
Bibliography
REFERENCES
1. http://www.surgeryencyclopedia.com/Ce-Fi/Discharge-from-theHospital.html#ixzz3AqZntJy6
2. Improving Patients Discharge Process in Hospitals by using Six Sigma Approach by

Mahmoud A. El-Banna. Website: http://waset.org/publications/7844/improvingpatients-discharge-process-in-hospitals-by-using-six-sigma-approach.
3. A Tool for Improving Patient Discharge Process and Hospital Communication
Practices: the Patient Tracker by Christopher G. Maloney, Douglas Wolfe, Per H.
Gesteland, Joe W. Hales, and Flory L. Nkoy, PMC , US National Library of Medicine
National Institutes of Health.
Website:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655791/
4. http://www.nhs.uk/CarersDirect/guide/practicalsupport/Pages/hospitaldischarge.aspx
5. Published June 2006 issue of Today's Hospitalist - See more at:
http://www.todayshospitalist.com/index.php?b=articles_read&cnt=151#st
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What is the research methodology used in the study?

What is the research methodology used in the study?

What are the objectives of the study?

What are the objectives of the study?

A Dissertation Synopsis

A Study of Discharge Process of Oncology Department with a view to reduce

International Oncology Cancer Centre, Fortis Hospital, Noida

Dr. Bhavya Agarwal

Under the guidance of

FLOW PROCESS OF DISCHARGE OF PATIENTS

Doctor checks patient for any

Discharge process initiated by nurse

Activity book containing discharge initiation papers

Patients attendant receives message from billing and

GDA comes back to the Day care after giving the

Indented medicines and Instructions given

Patient moves out of bed

Bed made ready for next patient

To study the process flow of discharge time of Onco Day Care.

Discharge Assessment and care plan[4]

Analysis of the primary data.

Data is collected from the Day Care.

Primary data has been collected manually.

Simple random sampling

RESEARCH QUESTION AND HYPOTHESES

H1 There is significant reduction in time after the implementation of suggestions.

SIGNIFICANCE OF THE STUDY

Chapter Division / Theme of the study

2. Improving Patients Discharge Process in Hospitals by using Six Sigma Approach by

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