Hospitals are under pressure to match supply with increasing demand as well as ensuring patient safety and satisfaction. One of the challenges occur in patient discharge process. In our senior design project, the aim is to reduce orthopedic inpatients’ discharge time.

Discharge time is the time when patients are allowed to leave the hospital after a medical procedure. The discharge process starts with doctors’ rounds, where doctors check on their patients after the surgery, update them on their condition and order the patients’ discharge. After completing the rounds, the doctors go to the medical transcriptionist (MT) to give her an update on the rounds. The MT inputs the medication, writes the discharge notes, sick leave, and escorts’ letter, which is later confirmed by the doctor. Finally, the patient is ready for discharge. 

The team has applied various tools and methods to achieve the local hospital’s desired outcomes. First and foremost, the team constructed a Value Stream Map (VSM), which is an essential lean tool that aids in visualizing the current process and identifies possible improvement potentials in every stage of the process. Moreover, the team used simulation to mimic the process and understand its dynamic nature then proceed with interpreting the results using statistics. In addition, a fishbone diagram was used in order to categorize all potential causes of our targeted issue and identify potential root causes. Using the above tools, we have proceeded with applying Six Sigma DMAIC to focus on better understanding customers' requirements, eliminating defects causing variations in quality, increasing operational efficiency, and improving the organization's financial performance. Finally, the team has taken benefit of all the tools applied to perform the necessary statistical analysis.  

Next, using these findings, the team generated alternative feasible solutions and concepts using several techniques: brainstorming, discussions with the client, research and analysis tools. The team’s main focus in the brainstorming session was the generation of the largest number of ideas using the members’ creativity and innovative minds to come up with solutions. Next, the ideas were narrowed down to the most practical ones. Discussion with the clients was also a source of the team’s inspiration for solution generation. Several suggestions made by the client were taken into consideration such as the involvement of the medical transcriptionist in the rounds. 

By the end of this milestone, the team has identified room for further improvement to generate better design concepts. First and foremost, the team has collected data for each of the fourteen doctors to emphasize the variation while doing the rounds. Not only that but the team has also performed a comparison between the two identified categories of doctors after more data collection sessions. In addition to that, the improved simulation models considered different days of the week, as well as, schedules. As for our suggested solutions, the team is now considering the cost of the proposed solutions under the light of preliminary results.