Improving Discharge Process at the University of Wisconsin Hospital: A System-Theoretic Method

This paper introduces a system-theoretic approach to improve inpatient discharge process at the University of Wisconsin (UW) Hospital. The complex hospital discharge process is modeled by a stochastic process with parallel subprocesses, splits, merges, and reworks. Then, a stochastic analysis method is introduced to evaluate the performance of discharge. Specifically, the waiting and service times are characterized by gamma distributions, and an efficient algorithm is presented to aggregate the multiple interacting subprocesses and calculate the mean, variability, and discharge-time performance, i.e., the probability to discharge a patient within a desired or given time interval. High accuracy in performance evaluation is obtained by using such a method. To improve the discharge process at UW Hospital, bottleneck and what-if analyses are carried out and improvement recommendations are discussed. Note to Practitioners - Hospital discharge is a complex process with substantial variabilities and challenges. Delays in discharge are common and become a nationwide problem. Although significant efforts have been devoted to improving the discharge process, most of the studies are qualitative or case specific. Thus, there is a need to develop a mathematical model to systematically characterize the discharge process, analyze the performance, and investigate improvement options, which can provide a fresh look from the system perspective. In this paper, we introduce a system-theoretic approach to evaluate and improve the inpatient discharge process at the University of Wisconsin (UW) Hospital. The discharge process is represented by a complex network consisting of multiple stochastic subprocesses, as well as splits, merges, and reworks. In addition to evaluating mean and variance of the discharge time, we introduce the notion of discharge-time performance (DTP), which is the probability to discharge a patient within a desired time interval, and an approximation method to calculate DTP. Moreover, we carry out a bottleneck analysis to identify the most critical step impeding the discharge process in the strongest manner. We also present recommendations to improve the discharge process at UW Hospital. © 2019 IEEE.