Purpose for the Program
The purpose of the project was to improve the throughput and discharge timeliness of mother–baby couplets. The capacity on the mother–baby unit delayed care of the patients admitted to the labor and delivery unit for treatment and delivery. Six Sigma methodology application was enlisted to improve the care at discharge and provide a seamless discharge transition. Baseline measurements revealed that only 30% of mother–baby couplets was discharged by noon.
The maternity throughput goals were to improve the rate of patients discharged by 12 p.m. from 31.5% to 50%, to have 75% of mother–baby couplets depart from the unit within 90 minutes of the last discharge, and to improve the skill level of the charge nurse to manage throughput.
Implementation, Outcomes, and Evaluation
An interdisciplinary team addressed processes. The methodology of Lean Six Sigma was applied. An improvement of 1.5% (30.5%) was noted. Areas that were stabilized through collaboration of the team were the services provided the day before discharge. Baseline data concluded that 69.1% of discharged patients left after 12 p.m., 55% of the deliveries occurred during the scheduled time frame, and low throughput. Lack of capacity to accommodate patients during periods of the day was identified. Stabilization of services before the day of discharge did not significantly improve throughput. The following processes on the day of discharge were not addressed: charge nurse ability, staff nurse ability, patient readiness for discharge, infant care, and physician discharge timeliness. The strategy for improvement included prepared designated charge nurses, a maternity discharge workflow indicator, and rapid cycle testing. The charge nurse ability was improved. The electronic discharge alert for mother and for infant was created. The maternity expected discharge list was completed each evening. Lactation consultation and documentation was developed within the electronic medical record. Phototherapy equipment consignment eliminated the wait for delivery and decreased readmissions for hyperbilirubinemia. The use of teletracking and transport aide expedited patients leaving the unit and maternity staff remained to care for other patients. Rapid cycle outcomes indicated that 47% of mother–baby couplets left the unit within rapid cycle three. The number of departures from the unit that took place within 90 minutes of the last discharge declined. Individual services and personal choice affected the data for couplet discharges. Average discharge time by 12 p.m. improved to 83%. A 12 p.m. discharge time has been normalized with correlation of consistency of application of processes.
Implications for Nursing Practice
Improved staffing ratios enhanced the ability to promote discharge timeliness. Patient perception improved and documentation for lactation services improved quality of care. Newborn readmissions declined by 75%.