Table 2.

Second PDCA cycle interventions aimed at reducing discharge cycle time

Aim	Strategy	Action	Responsibility	Time frame
To reduce discharge cycle time	Early discharge planning	Starting discharge planning from the date of admission.	CM department	September 2019–ongoing
		Ensuring timely patient referral (to physiotherapy, social worker, home healthcare and rehabilitation) as per treatment plan prior to discharge.	Case managers and discharge coordinators	September 2019–ongoing
		Developing comprehensive preliminary discharge plans to meet the ongoing medical and social needs of patients after discharge. Ensuring discharge criteria are met (preparing discharge summary, medications and OPD follow-up). Completing patient reassessment prior to discharge.	MRP and case managers	September 2019–ongoing
		Enhancing communication among care team members and with patients and family members. Arranging MDT meetings with family members as needed.	CM department	September 2019–ongoing
	Improving efficiency and coordination of the discharge process	Studying discharge process using Lean methodology	CQI & PS department	November 2019
		Assigning a discharge coordinator to oversee the discharge process: Participating in the daily morning roundsto remove obstacles and ensure streamlining of the discharge process. Monitoring the compliance of physicians with generating accurate, updated preliminary discharge orders.	Discharge coordinators and MRPs	September 2019–ongoing
		Converting internal to external activities: Preparing and documenting the preliminary discharge order night before discharge and drafting the final discharge summary. Preparing medical supplies and equipment needed for the patient upon discharge. Ensuring medical clearance of patients by other departments involved in patient care.	Case managers, bed managers, discharge coordinators, nurses, MMD and MRP	September 2019–ongoing
		Eliminating or reducing waste in the process: Transitioning from manual to electronic prescription. Converting supply requisitions for medical supplies and devices from manual to electronic. Conversion of an OPD appointment from a manual appointment slip to SMS notifications.	Pharmacy department, MMD, OPD, medical administration and ICT department	September 2019–ongoing
		Patients for discharge are seen first in the morning rounds.	Medical administration and MRP
		Final discharge order and medication prescription were finished before 9:00.	Medical administration and MRP

CM, case management; CQI &PS, continuous quality improvement & patient safety; ED, emergency department; ICT, information and communication technology; MDT, multidisciplinary team; MMD, materials management department; MRP, most responsible physician; OPD, outpatient department.