Background: To relieve hospital capacity strain, hospitals often encourage clinicians to prioritize early morning discharges which may have unintended consequences. We aimed to test the effects of hospitalist physicians rounding on discharging patients first.

Methods: Prospective, multi-center randomized controlled trial at three large academic hospitals. Participants were Hospital Medicine attending-level physicians and patients the physicians cared for during the study who were at least 18 years of age, admitted to a Medicine service, and assigned by standard practice to a general medical hospitalist team. Physicians were randomized to: (1) rounding on discharging patients first, as care allowed or (2) usual practice. Main outcome measure was hospitalist discharge order time. Secondary outcomes were actual discharge time, length of stay (LOS), and procedure order time. We used multivariable linear mixed modeling, adjusted for patient-level, clinician-level, and team-level covariates hypothesized a priori to be associated with the outcomes.

Results: Across three hospitals, 4,437 patients were discharged by 59 physicians randomized to prioritize discharging patients first or round per usual practice during the 6-month study period. Demographics are shown in Table 1. In primary analyses comparing physicians by randomized assignment (intention-to-treat), findings showed no significant difference for discharge order time (13:03 + 2h:31m vs 13:11 + 2h:33m) or discharge time (15:22 + 2h:50m vs 15:21 + 2h:50m) for physicians randomized to round on discharging patients first compared to physicians randomized to round using their usual style and similarly there was no significant change in length of stay (75 (IQR: 45, 141) vs 78 (46,144) (Table 2).

Conclusions: Rounding on discharging patients did not result in earlier discharges or a significantly reduced length of stay.Trial registration: number, NCT05370638Funding Source: Agency for Healthcare Research and Quality (1R03HS027231-01A1)

IMAGE 1: Table 1. Clinician and team-level demographics

IMAGE 2: Table 2. Unadjusted and adjusted patient-level outcomes by group