Background: Hospital discharges early in the day help facilitate patient throughput and improve capacity. A key step in the discharge process is the entry of the physician discharge order. The degree of variation in physician discharge order time has not been explored.
Methods: We identified all patient discharges from two general pediatric services at a single children’s hospital between April 2014 and October 2015. Each service included an attending physician for one week at a time and a resident team (senior resident and two interns) each month. All teams used a standardized in-room rounding style. The order time for each discharge was obtained from the electronic medical record and the mean order time for each attending and resident team was calculated. We used fixed-effect regression estimators (as appropriate for the continuous or limited dependent variables), controlling for unit, service, and weekend vs. weekday, to determine the proportion of the variance in order time which was attributable to physicians.
Results: We identified 2,858 discharge order times written by 38 different resident/intern teams, supervised by 21 different attending physicians. Mean discharge order time was approximately 1 pm. Individual attending mean order times ranged from 12:30 pm to 2:12 pm (mean SD, 29 min); mean resident team times ranged from 11:45 am to 3 pm (mean SD, 42 min). Discharge order time did not decrease through each month block as resident teams gained more experience. In fixed-effect regression analysis, 1.9% of the variance in order time could be attributed to the attending physician, while 5.3% could be attributed to the resident team.
Conclusions: The mean physician discharge order time at an academic children’s hospital varied modestly between attending physicians. Differences in mean order times were greater between resident teams, but did not improve with more ward experience (later in each month-long rotation). The amount of overall variation in discharge order time that was attributable to physicians in this system was very small. This information may help focus improvement efforts to facilitate early patient discharges.