a novel way of a Discharge planning project for in- patients in major secondary care hospital in Ba
Ministry of health

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Bahrain; the smallest Arab’s Region country; is the most densely populated country with around 1,454 inhabitants per square kilometer. In contrast, Bahrain has an increasing population size which ranged from 360 thousand in 1980 to approximately 1.3 million in 2010 and is expected to reach 1.8 million in 2050. In addition, the population life expectancy increased from 70.5 years to 75.8 years which is projected to reach 81.4 years for the period 2045-2050. As a result Bahrain’s elderly population is increasing and is expected to reach 18.2 per cent in 2050. Another dominant feature is the large and growing volume of inflow migration. As a consequence of all these population trends there has been a major discrepancy between supply and demand. In the medical field, one of the most critical challenges for health care providers is pending admissions secondary to the limited number of available bed this resulted in prolonged emergency waiting hours, increased costs and patients complains and reduced quality of service provided. Especially for the poor and the immigrant as it is the main governmental hospital in the country. We were faced with long waiting lists of patients that are could wait in the emergency room for up to one week before finding a bed in the hospital. That created a great pressure on health system as how to provide the best care for the patients in the crowded emergency room. There were a lot of complaints from the patients on a daily basis and it was reported all the time in the daily local newspapers. Our project was deigned to make all our service accessible to all the patients attending our hospital and we were aiming to sustain it. In order to overcome these obstacles we have implemented the discharge assessment project. The primary outcome of our project was accelerating the patient’s discharge process to reduce the number of pending admissions. The main idea of the project is to collaborate with all concerned parties such as physicians, social workers, nurses, pharmacists, patients, family members, administration, bed utilization service and transportation services in order to put a structured plan for pre-planned discharge plan. It was based on deciding about the possible day of discharge based on the clinical diagnosis from the first day of admission with daily follow up from the treating team and from the discharge planning team which was basically based on the medical residents and nurses. Then one day before discharge all the needed elements for the discharge has to be ready include informing the family, planning the medication and complete other diagnostic or treatment needs. As a result of this innovative project, which was run basically by a group of talented residents from the medical department in collaboration with other cornered parties. Our quality of service improved with a reduction in the emergency waiting hours, increased number of available beds, accelerated bed turnover process and improved patient satisfaction.

B. Strategic Approach

 2. What was the solution?
In 2008, the kingdom of Bahrain established the Bahrain Center for Excellence (BCE). The establishment of the center aims to achieve creative and sustainable solutions in line with Bahrain's Vision 2030. The Centre aims at improving initiatives, empowerment, excellence and management of knowledge in the public sector in order to improve the performance of government work to the highest levels. As part of the excellence program and in order to improve the quality of service provided by the Ministry Of Health in the kingdom of Bahrain we have established the discharge assessment program in the department of internal medicine at Salmaniya Medical Complex; the largest governmental tertiary hospital in the Kingdom of Bahrain. Our project was established in October 2012. We started with a pilot study in one of the internal department wards with five auditors. In March 2013, four wards were included and by May 2013 we have included other departments in our complex including hematology, neurology and nephrology department. Data auditing was manual in the beginning and ended up by electronic data collection and analysis on a weekly basis. Our goal was to improve the quality of our service. To achieve this goal, we started by setting our main objectives which were decreasing the number of pending admissions and minimizing the average waiting hours in the emergency department and early discharge of authorized patients. Our strategy for achieving these objectives started by creating the discharge assessment team. The team leader was the internal medical department chairperson and the members were highly selected medical residents. We have also included medical wards stuff nurses and representative from the administration, emergency department, pharmacy, information technology (IT) and the laboratory department. The actual work started by measuring our performance to identify and eliminate the challenges. After data collection we concluded that emergency pending admission was not just a problem, but one that requires hospital-wide solutions. Selecting the right strategy is paramount for any successful intervention. We started our improvement strategy by identifying the most likely causes of the pending admissions, reviewing the available materials and considering the resources. Our strategy was to establish the pre-discharge assessment plan, with active participation form all the involved parties including the patients and their family, To facilitate the discharge process, complete the discharge documents and medications before 10 am, inform patient’s relatives on time about the discharge plan and facilitate and ease the process of getting the discharged medications and patient transportation. By implementing this strategy, our department solved the problems associated with prolonged emergency pending admissions. We were able to decrease the average emergency waiting hours from 20 to 4 hours. In addition, the percentage of patients who were discharged within the expected day improved from 40-60% to 85-95%. All these measures provide a clear and compelling example of the way in which our department is striving to meet the goals and missions of the Ministry Of Health and the government of the Kingdom Of Bahrain to improve the quality of healthcare which is directly linked to Bahrain’s Health Agenda and the objectives of the Economic Vision 2030.

 3. How did the initiative solve the problem and improve people’s lives?
We started our project by addressing the main challenges and looked for solutions. Our biggest dilemma was improving the quality of healthcare provided. Improving the Pending admissions was one of the main objectives. Emergency pending admissions is costly. In addition, it compromises care quality and community trust. Our project was innovative in the way it was conducted and the way it was sustained. The way it is conducted by mainly medical residents where the project became part of their daily work and make them engaged in the planning and improving of the health care system they work in. we conducted this project with no extra costs. Before starting our project there has been a paucity of data on the percentage and cost of pending admission and the average waiting hours in emergency. By having a clear pre-discharge plan we were able to facilitate the process of patient discharge and the rate of bed turn over. A typical bed cost per day in our hospital is around 220 BD and approximately 9.2 BD per hour. In January 2013, the average emergency waiting hour was 20. By August 2013, it reached 4 hours with an average saving of 29440 BD. The percentage of discharged patients who left the hospital before 4 pm was around 4%. This figure reached up to 60-90% after implementing our project. By the end we were able to reach our primary and main goals which are high quality of healthcare service provided and patient’s satisfaction. We were able to achieve our goal through active participation of all the stakeholders, continuous monitoring and auditing and changing organizational cultures to attain the sustainability we are looking for and creating new leaders for the health system in kingdom of Bahrain .

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The strategy of the project was part of the general strategy of the ministry of health in Bahrain and was implemented according to the clear missions and objectives defined in Bahrain’s economic vision 2030 as well as of Bahrain’s Health Agenda. At all times, our central goal was to ensure the availability of high quality service to all population. The initiative was conducted according to 5 key phases. (1) observation and planning The project began by studying and evaluating the status and the quality of the service provided by our department. Salmaniya medical complex serves around one million of the Bahraini citizens with a total number of around 40,963 admissions per year. Although most of these admissions are under the care of the internal medicine, the department is responsible for a total of 221 inpatient beds only. As a result, one of the main challenges to our department was the large number of pending admission in the emergency department. In 2010, the average number of pending admissions was 40 admissions per day. Our proposed solution was managing patient’s discharge process via developing a system for early discharge of authorized patients. We planned to start in the medical department as it is the largest departments in the hospital with a bed capacity of 250 beds in 13 wards in the hospital. (2) Piloting The project started in October 2012 with a pilot study by enrolling five auditors to monitor the discharge process in four out of 13 of the internal medical department wards. The auditors were highly selected medical residents in order to insure the continuity and sustainability of the process. The initial piloting period was closely monitored with daily updates and meeting to ensure that it is being conducted properly to achieve our goals with a great level of transparency. There was a twice daily rounds ion the wards at 9 am and another one at 12 noon to ensure that the pre discharge plan is ready one day earlier and them to ensure in the day of discharge that the process went smoothly and start collecting data. A checklist was created by the team and it was modified and edited 5 times based in the needs and the obstacles we faced. The initial results from the analysis were encouraging. (3) Scaling In March 2013, with an aim of empowering our project all the medical wards were included and by May 2013, all the divisions under the medical departments were enrolled including hematology, neurology and nephrology departments. We have started data collection manually and ended with electronic data sheets using Microsoft Excel program for data entering and analysis. We created innovative software for data entry in each ward and to be analyzed by one of the medical resident and then the results are sent to the ad of the departments and to the administration to be utilized for decision making and further planning. (4) monitoring and refinement In order to ensure the continuity and sustainability of our project, weekly meetings were conducted between the members of the project. During which new suggestions, obstacles, updates and data analysis and results were discussed with a great level of transparency in order to maintain sustainability of the project. (5) reflection In addition, regular meetings were organized with experts from the Bahrain Centre for Excellence, other departments in the complex, administration and representatives of stakeholders in the project including bed utilization, pharmacy, Information Technology (IT) and the laboratory department. In order to facilitate the early discharge process, the laboratory department participated by speeding up the process of issuing the laboratory results. Adding to that, a new section was established in the pharmacy for discharged patients to facilitate the discharge process.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
This innovative initiative was implemented in the medical department as it is the largest department in the hospital and thus contained more number of patients than the other departments. It basically covers a round 240 beds. The main stakeholders: 1. the administration : helped in getting the team formulated and give all the support to the progress and daily needs for the successful outcomes 2. Medical department: with all the staff: chairperson, consultants, medical resident s: who were the cornerstone for formulating the team , running the daily round , entering the data analyzing the data and communicating with other stakeholders with transparency . 3. Nursing department: the nurses play critical role in formulating the team, helping ij daily rounds , communicating with the other stakeholders, following the patients , discussion of the management plan and discharge plan with the patient and the family members. 4. Patients : the most important stakeholders in the team were the patients as we were communicating with them on daily basis. That had changed the equation and increase the level of patients satisfaction. we have done a patient satisfaction survey which reflected the high rating for the project and the way it has been conducted. 5. Bed utilization: play an essential role in following with us the discharged plan and ensure that everything is ready for the patients at the time of discharge. They were following the beds availability and then infirm the emergency room staff to transfer the patients immediately to the room that are ready. Applying the concepts for hospitality. 6. Social service: they had a great role in communicating with the family members and the patients in order to ensure that they have answered their quarries and they understand the discharge plan 7. Paramedics and Ambulance services: where we need their help in transferring patients who needed a transfer to their homes to the nursing home. 8. Primary care service: where we improved our commucnation with them in order to follow the discharge plan and for the patients to follow with their primary care physicians and do not loose their follow up. 9. The nursing home: where they played an essential, role in communicating with the team about the available beds and early transfer of the patients to their facility. 10. IT department by developing the electronic form thus making the project easier to transfer to other wards and departments and so it can be used in all the departments in the hospital
 6. How was the strategy implemented and what resources were mobilized?
The implementation of this project was part of a wider organizational plan and aiming for changing the existing culture in the institution. What makes our initiative a unique project and made stand out among the others, is that it was done at no extra cost and on other hand we were saving money through the better utilization of the existing number of beds. We had to mobilize the following resources; 1. Human resources: The human power used in the project was already available in the hospital. This includes doctors, Nurses, paramedics, clerks, social workers and IT technicians. The innovative part of this project is that we made the same people around us taking care of the problem by empowering them. We were conducting regular meetings and improved our communications through the organization in order to get more people interested and willing to participate in the project. Through the implementation of the pilot part of the project we were concentrating in selecting the team members and disseminating the idea of team work and proper collaboration. 2. Technical: The infra-structure needed for the project -such as computers, intranet (network) and printers- was already existing in the hospital and available in each ward. The members we selected in the team they have a lot of skills , one of them were their computer skills which helped a lot if creating the different forms : the checklist for the pre-planned discharge. The online from and the patient satisfaction forms. 3. Financial: The project didn’t require any kind of funding as all required human power and the infrastructure was already available. All it needed is some extra work and organization between those who were involved in the initiation of the project and later on with those who joined the project to help solve the identified problems. Never the less, the project has reduced the costs of the hospital by reducing the length of stay of the patient and speeding up the discharge process were a lot of beds were utilized in better way. Through early discharge and decreasing the length of stay.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The main outputs of this project were as follow: 1. Decreasing the length of stay of the patients: by putting a proper pre discharge plan and more transparent communication among the stakeholders, we were able to decrease the length of stay in most of the common medical diagnosis. 2. Increase patient satisfaction: as the patients are out main customers and in order to provide equality of services for all the residents and citizen in the kingdom of Bahrain , we were able to increase the level of patients satisfaction. We had a lot of great comment and quotes from the patients as the major difference in the situation now. 3. Saving a lot of money : be implementing this project we were able to decrease the waiting time of the patients in the emergency room ,facilitate the early discharge , so we were able to use the beds for other patients without increasing the number of beds. 4. Database: we were bale through this project to create a database for admissions and discharges in the organization which can be used by the higher authority for decision making. Although the project was built on collecting data about discharges, the aim was to use this data to speed up the discharge process without affecting the quality of the service provided. In relatively short time, the data collected amazingly highlighted several points that caused significant delay in the discharge process. With further follow-up and after several meetings with colleagues form other departments we were able to reduce the time or eliminate some points of the discharge process. This was reflected directly on the data collected showing noticeable reduction in discharge time. This effect quickly propagated to other sections of the hospital specially the emergency department were there was decline in pending admissions. This results in less crowding of patients in ER, which meant healthier atmosphere along with better care form health providers.

 8. What were the most successful outputs and why was the initiative effective?
The project itself was built for monitoring. This provided an advantage to us as any step taken to resolve the problem was directly measured. Throughout the project adjustment to the electronic form was made to make it suitable to measure whatever additional data needed, thus increasing its power for monitoring. The database was an innovation as it provided a background to not only monitor the targeted information regarding discharges but also gave us the opportunity to look at other things like the flow of patients in each ward and the distribution of patients among the different specialties or consultants. In addition, the revolution the database made was its ability to measure the length of stay of patients by diseases. By this we had a clearer view of which disease are taking more beds over longer periods. We also compared the results with the international data trying to improve the length of stay in the hospital. By regular meetings with other departments involved in the project continuous feedback about the project was provided insuring the main objectives of the project were met. Furthermore, the patient questioner was another tool used to monitor the satisfaction of patient thought out the project, thus insuring the quality of the service provided was improving or at least not affected. So the projects was created on the following cornerstones which ensured continuous monitoring, auditing and evaluation: 1. Selecting of highly motivated members for the team 2. Regular meeting with all stakeholders weekly 3. Regular meeting with the monitoring team daily 4. Creating a software which is easily accessible and we pull report on a weekly basis 5. The monitoring team do twice daily round to ensure that the forms are filled and the data are entered and the patients had left on time satisfied. 6. Regular feedback are provided for stakeholders and the administration 7. Regular reports are generated and shred among the stakeholders to give feedback and improve the process 8. Because of the above rigorous follow up and monitoring our forms and checklists were modified 5 times to reach the best way.

 9. What were the main obstacles encountered and how were they overcome?
What were the main obstacles encountered and how were they overcome? Obstacle name: Lack of patient satisfaction and trust in the current health system Challenge: we were faced with a high level of dissatisfaction and no trust from the patients Solution: To ensure the satisfaction of the patients and provide health services at high levels with equality and transparency. We provided a questionnaire to evaluate the performance of the doctors and nurses, the flexibility of admission and discharge process, the hospital services, the commitment to professional ethics and adequate explanation of the patient’s condition as well as the available treatment options were addressed. The result of the questionnaire and the impact on the patient’s satisfaction were discussed with the doctors, and several meetings were held to address the problem and solve it. We had monitored the doctors and nurses very closely through our auditing team to solve the problems and to ensure the efficiency of the early discharge plans and following the patient’s laboratory results and the consultations as well as solving the social issues which may cause delay to the discharged patients. 80% of the patients have evaluated the discharge process as excellent out of 77 patients which were the initial sample for the patient satisfaction survey. Outcome: This results in improvement of the health services provided to the patient that lead to his satisfaction through getting the appropriate health service in the appropriate time, getting the laboratory results as soon as needed and having the discharges early, which allow to decrease the pending admissions and give better emergency service. The average of the number of pending admissions has markedly decreased from 40 in January 2013 to only 4 by June 2013. Obstacle 2: Obstacle name: lack of database with the required details for each department to enable them for forecasting and intelligence. Challenge: we were faced with the lack of a database or any kind of registry to start the project and to monitor its progress. Solution: We innovate a database with all the required details for each department because of the lack of the data in the period prior to the initiative about the number of pending admissions in the emergency, the waiting time for each patient and the delayed discharges in the wards for different reasons and the patient satisfaction about the health care service provided. We start to make a database through collecting the data and information starting from emergency and medical department and then to the other departments to address the size of the problem and find the solutions. We started with a small team and few wards initially then expand to the other wards. We increased the number of the team and auditors to cover most of the medical wards in addition to the weekly meetings with the team members and members of other departments to ensure the accessibility of the database to the other departments and we created the on line discharge electronic form on the intranet to facilitate the data entry, collection and analysis. Outcome: This has built a solid database about the number and time of pending admissions and the causes beyond the delay of discharge from wards. So we reduced the patient waiting time in emergency from 20 hours to 4 hours which has reduced the cost from 4400 BD to 880 BD per day, speed the patient transfer to wards and getting the discharged patients out on time , the number of discharged patients before 4 pm has improved from 4% to 85%. Obstacle 3: Obstacle name: inability of the team to handle the administrative work. Challenge: we were faced as physicians that we are not trained to be administrators or to run quality projects especially among the most junior physicians who do not have the experience. Solution: To face the problem of the lack of experience in the administrative work, we arranged several meetings to the members of the initiative to improve their administrative skills, so the team was trained academically through several meetings with administrative expertise. Outcome: It creates a competition among the initiative members and improves their work quality from the data collection to the analysis and application, and helps them to collaborate in many other projects that enhanced the health care and the patient satisfaction.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
What is the key benefits resulting from the initiative? Kingdom of Bahrain strived to provide a maximum integrated health care to the patients through improving the health care quality in all health aspects since the last century to enhance patient health and satisfaction. The project started in October 2012 to solve the problem of the large number of pending admissions in the emergency with its burden load on patients health and the ministry budget, and the long waiting hours in emergency department for patients to receive needed health care. Our medical team has innovated the online electronic discharge form to facilitate the early discharge of authorized patient and therefore increase the bed turn over, decrease the pending admission and minimizing the patient waiting hours in emergency. We applied the form in the medical wards then expand it to the different specialties, to reduce the suffering of patients and their families by providing an outstanding and quick service for patients attending emergency department. The results came impressive in the form of increasing the capacity of the beds in the emergency department capable of receiving the largest possible number of patients attending emergency especially with the increasing number of the population of kingdom of Bahrain in the last ten years. By facilitating the rapid transfer of the pending admitted patients in the emergency department to the general wards, we decreased the pressure load on the emergency department and so ensure the accessibility of timed best care and treatment to the patients with equality. The project helped to deliver the fast needed treatment to the critically sick patients who need urgent life saving intervention and procedures without delay. The innovation of the electronic form has contributed to a better care among the discharged patients by informing them about the expected discharge date to prepare any accommodation, writing the discharge plan and getting the discharge medications before 10 am, patients were fully instructed about the discharge medication and follow up plan, the residents and the nurses were encouraged to follow the results of investigations and consultations needed and informing the relatives about the ongoing plan and prognosis this has improve the percentage of patients who were discharged within the expected day from 40-60 % to 85-95% , in addition it has built a strong bond between the patient and their families with health care providers and enhanced the confidence and satisfaction about the health care services. The family was involved in the discharge process as well by instructing them about medication use and follow up plan and encouraging them to take patients out on time to prevent complications like misunderstanding of treatment plan or increasing infection rate secondary to unnecessary stay. Their contribution in the health services created a spirit of cooperation among the individuals of the Bahraini society to establish moral values and support the public benefit. The acceleration of the discharge process impacted on the other services as well and caused marked improvement in their performance, pharmacy has allocated a special counter to supply medication to the discharged patient, the laboratory workers helped in preparing the investigations needed on time, the transport department help to deliver patients to their residency place with a companion to ensure their safety, the cleaners were involved as well to prepare the bed to the new patients to avoid delay in receiving them. This has enhanced the concept of teamwork, which is the main bracket to a successful work. On the other hand reducing the need of increasing the number of beds and the number of the health care workers, decreasing the rate of infection resulted from unnecessary stay. The cost of hospital stay secondary to infection decreased from 7480 BD (10000 USD) to 440 BD (1100 USD) with saving of around 3080 BD (9000 USD). As well as, decreasing the total cost, and so enhancing the economy of the kingdom. The initiative led to acquisition of a wide management experiences among the medical team through the regular meetings and sharing the ideas together, the innovation of the database and online electronic forms which helped in improving their management skill and self-implement new projects to enhance the initiative competency continuity, like the electronic based project for the admission and discharge, measuring the patients satisfaction on the quality of the medical services, peer review management application, review and application of special protocols for the different diseases.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Is the initiative sustainable and transferable? Financial: The project has performed an extensive financial modeling of the cost saving. Our medical team has volunteered to design the online discharge form and expand it to the other services without fund from ministry of health. The medical team was the main human resource that worked in the project and monitored its flow and accomplishment. Social: Upon the application of the online electronic discharge form, the percentage of the discharges before 4 pm increased from 4% to 85%, which reduced the number of patient waiting for bed in emergency. This has achieved a better patient care and satisfaction about the health care services. Economic: Our medical team has collaborated with the health care workers to provide the project with high efficiency with out the need of increasing the number of the medical workers. The plan has enhanced the patient timed discharge and so decreased the need to increase the beds number to receive more patients. It enhanced the economy of the kingdom by reducing the hospital stay cost by 242 BD for each patient. Cultural: The project has encouraged the patients and their families in participating in the management plan and taking responsibility like taking the discharged patient out on time and following the doctor discharge plan from medication to follow up. Environmental: The project has dramatically reform the image of the hospital by fostering a better relation with patients and their families through improving the patient safety by encouraging the timed patient out, and providing transport to patients if needed, this has contributed in decreasing the complications and infection rate and its complications resulted from un necessary hospital stay. Institutional: The patients are instructed about their discharge plan in advance. A medication copy given to the patient and the other to the primary health care this helped in decreasing the readmission due to inadequate understanding of post discharge care need including complicated treatment regimen or follow up from different health care providers. Regulatory: The form provides basic patient information as well as admission and discharge dates, name of physicians who provided care, patient diagnosis, test results, a summary of the most important treatment interventions received in the hospital and required follow up appointments. The instructions are written in first person language to enhance patient understanding and attachment to the information. The electronic discharge form was rolled out to most of the wards through the hospital. The positive engagement by doctors and the raised awareness about the importance of effective discharge practice helped to shorten patient waiting in emergency, most importantly change allows for timely access of high quality safety of our patients

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
What are the lessons learned? Plan: To Improve the medical care given for emergency cases 
and to Provide a special counter and an employee to facilitate medication supply from the pharmacy for the discharged patients and to Encourage early working on laboratory investigations for the discharged patients in addition to Facilitate easy and fast transport of discharged patients, in case of inability of their relatives to take them out of hospital on time. - Remarkable plans lead to remarkable performances, which lead to remarkable rewards. Therefore, spending enough time in making remarkable plans and preparing for a remarkable performance will pay off with extraordinary rewards. Our project started after several meeting in order to put the best plan that has to be successful. Plan ahead: A good plan is first step in success; by planning ahead we could identify the problems, categorize, prioritize and create a response plan. Unfortunately, many organizations do not succeed, especially when facing obstacles, because they don’t anticipate it or, if they do, they do not plan how to respond to them. - Becoming proactive: Without proper planning we would not be ready to respond to challenges. Hence we become reactive. Planning ahead helps you become proactive. - By becoming proactive, you will be able to take the right action in the face of challenge and adversity. As a result, you welcome change because you are ready for any type of challenge. When you are proactive, you respond to situations rather than reacting to them. Improving performance: By improving your performance through good planning and preparation, you will be clearer about what to do next. You will also experience less stress, be more productive, provide better service, deliver higher quality products, create a more joyful environment to work in, and become a more effective and influential leader. - Give enough time to develop a team: Team development is vital to success, projects, and the organization as a whole. Teams suffer without plans. Unfortunately, many organizations do not plan for team development. After a while, teams experience internal and external conflict, which results in confusion, low productivity, less creativity, dissociation and failure. Through the project we started with a small number and once we were able to ensure that we have the backbone to expand the services we trained and recruited more residents. - Revise and update your plan: Effective plans are revised and updated regularly. In fact, our original plans can and should evolve over time so we can stay on the right track and get to the destination. By planning ahead we give ourselves time to revise our plans based on updated information on risk, quality, resources, stakeholders, assumptions, and constraints. - To be innovative and try to create your own way of solving your problems instead of adopting a ready-made plan which will not fit your settings and will not give you the looked for outcomes And this was achieved through: 1. Ensuring availability of beds in the medical wards. 2. Shortening the waiting-time for the patient to get a bed. 3. Providing full, well-trained medical team specialized in patients' management plan. 4. Implementation and acceleration of the patient discharge plan. 5. Writing the discharge medications and the required documentation before 10:00 am. 6. Inform the patient's next of kin about the discharge time and emphasize on getting the patient out of hospital on time. 7. Providing a waiting area for the discharged patient. 8. Evaluating patient's satisfaction about the medical service via a questionnaire at time of discharge. 9. Entering all the patients' information (from admission to discharge) into an electronic database for analysis.

Contact Information

Institution Name:   Ministry of health
Institution Type:   Government Agency  
Contact Person:   Manal AlSairafi
Title:   Excellence Coordinator  
Telephone/ Fax:  
Institution's / Project's Website:  
E-mail:   msairafi@health.gov.bh  
Address:   Manama Bahrain
Postal Code:   00973
City:   Manama
State/Province:  
Country:  

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