Background: Targeted approaches for early discharge times have been utilized to improve patient flow, but literature shows sparse evidence for hospital-wide efforts and mixed benefits for the length of stay and readmission rates. Furthermore, there is limited data for this approach across a large academic medical center. We set an aim to increase the percentage of patients discharged by 11:00 am (DCB11%) from 8% to 25% within 18 months.
Methods: We undertook several intervention cycles within our adult academic medical center and freestanding children’s hospital with about 40,000 patient discharges per year. Utilizing January through November 2019 as baseline data, we began interventions in December 2019. Data collection is ongoing, but this abstract represents two PDSA cycles, ending in March 2021. Cycle one involved identifying and prioritizing two DCB11 patient candidates from every medical unit. Discharge medication reconciliation was to be done one day prior, and discharge orders were to be completed by 9:00 am. Cycle one also involved “Care Progression Huddles” piloted on four pilot units and then rolled out systemically over 6 months. These huddles incorporated an electronic discharge dashboard (Qventis Pathfinder) intercommunicable with our EHR (Epic). At these huddles, teams from each unit discussed discharge planning for all patients and identified at least 2 patients likely ready to discharge the following morning. Cycle two focused targeted efforts on underperforming units: DCB11 standard work was spread across all units, unit deep dives were performed, and specialty-specific improvements were implemented.
Results: Our main outcomes were the percentage of patients discharging and vacating their hospital room at 11:00 am each month (DCB11%) and length of stay divided by geometric mean length of stay (LOS/GMLOS). Our balance measure was to ensure we didn’t worsen our 30-day readmission rate. Process outcomes included the percentage of discharge orders by 9:00 am (DOB9%) and the percentage of patients with a predicted early discharge date by day two of admission (EDD documentation). DCB11% increased from 8.8% at baseline to 15.9% post-intervention (April 1, 2021 to June 30, 2021). DOB9% increased from 13.8% to 14.8%. LOS/GMLOS decreased from 1.54 to 1.46 days. The 30-day readmission rate, in fact, declined from 12.32% to 12.09%.
Conclusions: Our DCB11 system-wide interventions led to an almost 2-fold increase in DCB11 while decreasing LOS/GMLOS and without negatively impacting the 30-day readmission rate. This fell short of our goal of 25% DCB11, but at these times of high capacity and high stress, these changes represent substantial and meaningful improvements.