Background: Improving hospital throughput is a barrier facing medical facilities.  Poor throughput leads to prolonged patient wait times for beds, a cause of patient complaints.  Often these wait times are the result of late discharge times for admitted patients.  One focus of multidisciplinary rounds is early discharge, hoping to get admitted patients to their beds sooner to improve throughput and patient satisfaction.  Previously reported successful early discharge initiatives have generally been costly and labor intensive.  

Purpose: Our primary goal was to implement a low cost, easily reproducible process to increase early discharges at our institution.  We created a communication and accountability tool between interdisciplinary team members to encourage early discharges for the following day.  Our secondary goal was to identify specific barriers to early discharges.  

Description: We launched our early discharge pilot on two resident units during daily interdisciplinary rounds.  Discharge team members included the Hospitalist, resident, nurse manager, case manager, social worker and bedside RN.  During rounds, mutually agreed upon patients were identified as potential early discharge candidates for the following day.  A list of these patients was created by the nurse manager.  Potential barriers to discharge were determined during rounds and expedited by the nurse manager.  This list was distributed to the chief residents, hospitalist directors, social workers and case managers, and served as a guideline for tasks expected to be completed for the day.  Chief residents and/or hospitalist leadership checked in with resident providers once daily to follow up on each team’s progress.  All potential early discharge patients were reviewed the next day to evaluate discharge time and reasons for late or cancelled discharges. 

We reviewed data for the 10 months prior to protocol intervention and compared it with 2 months post protocol intervention.  Early discharges (defined as prior to 12:00pm) increased 25% post intervention.  Of the early discharges identified, 27% of the patients were successfully discharged before noon.  Unsuccessful discharges were categorized under medical, social work or case management barriers.  Feedback was given to responsible parties.  The majority of preventable barriers (defined as non-medical) were due to transportation issues.   

Conclusions:  Though still in its infancy, this low cost and easily reproducible discharge protocol focusing on communication and accountability has made an impact on our early discharges over a two month period.  Future directions include examining whether our early discharge protocol has impacted ER to hospital bed wait times, length of stay and patient satisfaction, as well as possible expansion to other inpatient units.