Background:
Despite some literature on the evolution of the “scheduled discharges”, many hospital administrations and outcomes management teams perceive afternoon discharges as opportunities to improve. We challenged that concept with a hypothesis that afternoon discharges would be a sign of an efficient hospitalist program and that we would find specific barriers to the discharge process.
Method:
We performed a retrospective chart review conducted by 3 physicians in the hospitalist program. We reviewed all discharges by our group over a 2 week period of time (totaling 70 patients) during august of 2005. Due to 100% compliance with computer order entry systems, we reviewed the time of discharge order placement, the time of the bed availability based on an order placed by housekeeping and reviewed the chart for written plans regarding discharge planning searching for any and all barriers.
Summary of Results:
The average time of discharge order by physicians was 12:22 pm and that of housekeeping completion was 2:07 pm. In 44% (31 of 70) of our patients the discharge order was placed by the physician before noon. Only 7 (10%) patients physically left the hospital before noon without any barriers or delays. The barriers we identified were broken into 5 broad categories with the most significant impact coming from “primary team” or “patient” areas.
We also discovered 12 patients (17%) that clearly should have been discharged the prior day. Of this 5 fell into the early discharge group. This suggests that 16% of before noon discharges are actual failures from the day before. 7 of these patients were actually seen during the later part of the work rounds and were subsequently discharged after noon.
Statement of Conclusions:
This article dispels the belief that all early morning discharges are successful discharges reflecting an increased efficiency over evening discharges. We have shown that a significant percentage of early morning discharges are in reality failures from the previous day. Furthermore we were able to identify key barriers and categorize them down into the most significant aspects. These categories and specific obstacles are translational and can serve as areas of further investigation
Author Disclosure Block:
B.P. Paladugu, None; A.L. Mookerjee, None; E. Kupersmith, None.