E‐Dip: Early Discharge Initiation Project. an Innovative Model for 1‐Day Admissions and Throughput

Background:

Improving throughput and length of stay (LOS) is essential for hospitals to operate efficiently and cost effectively. Patients who require 1‐day admissions who are not placed into observation status hold specific challenges, because the handoffs do not prepare the following ward team to discharge them upon their initial encounter. Due to this “new encounter inertia,” some patients may remain hospitalized for one additional day. We hypothesized that a system of flagging and communication from the admitting team to the following ward team would promote early (1‐day LOS) discharge for these patients.

Purpose:

Our goal was to create a system to enhance communication during night‐to‐day handoffs from the admitting team to the day hospitalist team to facilitate early discharge for patients with an anticipated 1‐day LOS.

Description:

We developed a novel protocol, the Early Discharge Initiation Project (E‐DIP), to promote discharge for patients who likely require a 1‐day admission. The E‐DIP team met twice per month to discuss updates and process improvements. PDSA cycles were employed using quantitative and qualitative data to revise and improve the protocol. This project was implemented on the non‐teaching hospitalist service. Each cycle started with the physician assistants or nocturnists performing admissions and identifying who may be discharged the following day. The E‐DIP protocol includes a paper list, verbal communication during handoffs, and an electronic medical record order signaling to the future teams about the 1‐day admission. Each morning, an email was sent to the day teams, along with a text page reminding them to see these identified patients early for discharge. The day team, consisting of nurse practitioners and day hospitalists, completed the discharges. Our prelim results from July to November 2013 demonstrate that the average number of 1‐day admissions increased by 67% following the initiation of the protocol (Table 1). The number of discharge orders before 11am per week increased by 14%, and the average number of patients leaving the hospital before 11am increased nearly 3.5‐fold. The average discharge time also improved by 28 minutes.

Conclusions:

E‐DIP was successful in improving throughput for 1‐day admissions and was associated with decreased overall length of stay for the Hospitalist Service. Future studies are needed to assess whether this protocol can also decrease LOS for patients entered into Observation Status who are transitioned to a hospital admission after staying for more than “2 midnights.”