Transforming the traditional discharge planning manual

The North Broward Medical Center's discharge planning manual transformation began when all staff acknowledged that the current process of maintaining 27 separate manuals for CM staff, various nursing stations, and one ambulatory clinic was impossible. The cost of each binder and supplies was $24.05, a total of $649.35 for the 27 binders. These resource binders were valued by some and disappeared altogether; others were so well hidden that they were not available when needed. The time and energy involved in locating these manuals to insert updates became exhausting and truly impossible. Updating the manuals was done less frequently, given the numerous barriers, further dissuading use of the resource.

To resolve the currency issue, team members identified all the barriers associated with maintaining the manuals and their causes. They decided to convert the manual into an electronic format and publish it on the North Broward Hospital District's intranet, thus extending its accessibility and availability. The subgroup in charge of the manual's transformation determined that the categories of the paper manual were still relevant and several new sections were needed. A review sheet (Figure 1) was developed and used with each section of the manual to document the review status and progress of the specific section. Current paper-based resources were reviewed to identify items that were still current and should be included, along with a list of resources to be added and the need to search for new resources.

View Large Image Download to PowerPoint

Figure 1.

Each team member was responsible for designated sections of the manual. A summer intern had the responsibility to type items that were not in electronic format, update and revise those items that were in electronic format, verify that resources entered were current with correct contact information, and perform the research to identify additional resources. Once the information was obtained, the intern collated the information, scanned forms so that they would be available in electronic format, and placed items in the prescribed order by section.

The completed electronic manual was forwarded to the CM information services (IS) liaison; she had the manual uploaded to the intranet within days. Education about the manual's availability and accessibility, including the “how-to-use” instructions (Figure 2), was provided in various forms, including placing announcements about the manual's availability on the district's home page; CM departments at sister facilities were alerted to its availability; all district department managers were provided with information in the monthly IS publication distributed at the monthly organizational staff meeting; and CM staff provided hands-on demonstrations to nursing staff.

View Large Image Download to PowerPoint

Figure 2.

Satisfaction surveys have indicated that employees beyond the CM department are regular users of the resources; in addition, select resources are printed for patients and families. Employees report that they have used the manual to locate resource information for family or personal problems without needing a coworker. Staff in the emergency department and clinics report being able to rapidly provide community resources without having to wait for social work staff, reducing wait times and increasing customer satisfaction.

The CM staff was so excited about the transformed resources that they featured it at the hospital's annual Quality Expo competition, and the project was selected to be a presentation at the South Florida Chapter of the American Society for Quality's 16th Annual Performance Excellence Showcase.