"Audit of efficacy of patient discharge process- Are we really up to the mark?”

Background: Procedural delays in discharge process are critical, yet remain a neglected area of patient care, resulting in frustration, financial losses and unnecessary bed-occupancy. Timely and effective communication of the discharge instructions are vital. Despite digitization, delays are common in routine practice. We audited the itemized timeframe of discharge process of a single department general ward. The patient attendant feedback of discharge instructions and overall satisfaction were collated and analyzed. This audit highlights the gaps which need to be addressed to improve the discharge experience. Methods and Material: Prospective enrolment of 100 sequential discharges from Paediatric surgery general ward with itemized documentation of time taken for each event. The attendants filled out feedback form about their understanding of discharge instructions and self-reported their overall satisfaction with discharge process. Statistical analysis: Descriptive statistics, one sample t test and Mann-Whitney U test using SPSS software.Results: 70% were elective admissions. The average turn-around-time(TOT) for discharge till bed clearance in Hospital Management information system(HMIS) in Self-paying group was 332 min(NABH Standard-180 min) and in Credit billing group was 397 min(NABH Standard-240 min). 95% of attendants expressed satisfaction with effective communication of instructions at time of discharge.Conclusions: Discharge process is significantly delayed in both groups compared to laid prescribed standards; more pronounced delays were noted in the credit billing patients. Single window operator billing process and lack of robust insurance processing systems were the main reasons for delay. Re-Audit after addressing these gaps would help attain the prescribed standards.