Background: Many hospitals have focused on discharging patients before noon as a goal to improve throughput and decrease length of stay. However, those patients who can be discharged early in the day may actually represent a loss and not a win for the system, as they could have potentially been discharged the evening before.
Methods: Retrospective analysis of 78,826 patients from a single tertiary care center between January 1st 2016 and December 31st 2018.
Results: Discharge before noon was independently associated with higher likelihood of LOS above the median, OR 1.26 [1.18-1.35], P<0.001, among medical patients. This association was not seen among surgical patients where DBN was associated with a shorter LOS (OR=0.78 [0.71-0.86] (P<0.001). Factors associated with higher LOS in both medical and surgical groups include higher Case Mix Index (CMI) (all patients 2.23 [2.18-2.29]), Medicaid payer, weekday discharges, and discharge to skilled nursing or rehabilitation facilities (all patients 4.3 [4.1-4.5]). For the variable readmission, discharge before noon in surgical patients was associated with a lower readmission rate OR=0.81[0.69-0.95], p=0.008. Factors associated with higher readmission include higher CMI, Medicaid, and Medicare insurance.
Conclusions: While early discharges must be balanced with ensuring safe transitions of care, this study identifies areas of opportunity among the broader population of discharged patients. The finding that DBN was associated with higher LOS among medical patients suggests that some patients may have been able to be safely discharged the evening prior. With surgical diagnoses, DBN was associated with a lower LOS and a lower risk of readmission. Patients with later discharges were more likely to have been sent to a rehabilitation center or SNF and were more frequently discharged during a weekday. Identification of these factors may help health systems transition patients safely and efficiently out of the hospital.