Background: Early, yet safe hospital discharges are a constant area of focus at tertiary care centers in order to maintain efficiency and patient flow. This is especially true at our institution, which acts as a referral center for 3 regional hospitals and 3 outpatient clinics, routinely carrying an inpatient census of 85-100%. Failure to complete discharges in a timely manner results in multiple adverse effects including bed inflexibility, delay of outside patient transfers, increased stress on staffing, and poor patient satisfaction.
In January 2013 it was proposed that certain interventional radiology (IR) post-procedure patients would be a suitable cohort to target for expedited discharge given their standardized plan of care and low complexity. This included patients undergoing transarterial chemoembolization (TACE) therapy for hepatocellular carcinoma. The interventions employed consisted of (1) transitioning patient care exclusively to a hospitalist-run primary service and (2) geographically localizing patients to our Short Stay Unit (SSU) rather than the general medical ward.
Purpose: To evaluate whether the institution of a hospitalist-driven post-procedure observation service resulted in a significant improvement in patient discharge times of post-TACE patients when compared to those cared for on a resident teaching service.
Description: Retrospective review of post-TACE patients admitted to both hospitalist and resident services from January 2013 through October 2015 was conducted. Patients were identified using the IR service TACE scheduling log, with subsequent manual chart review. Patients who had procedural complications and required admission for >24 hours were excluded. Discharge time was identified as the time the discharge note was electronically signed by the physician in our EMR, as this is the last step of the discharge process at our institution. The primary service and patient location at time of discharge were documented. Over this time period, a total of 20 patients were admitted to the resident service and 84 admitted to the hospitalist service. The average discharge time on resident and hospitalist-run services were 12:14 PM and 10:03 AM, respectively (p<0.0001). This difference persisted when comparing discharge times of the 9 resident and 82 hospitalist patients admitted to the SSU, with average discharges times of 11:57 AM and 9:59 AM, respectively (p<0.008).
Conclusions: Transitioning low-complexity post-procedure patients from resident to hospitalist-run services resulted in a statistically significant improvement in discharge time by approximately 2 hours, attributable to the care provider and not geographic location. This data suggests that identification and transition of additional low-complexity groups to a hospitalist-only team may result in earlier discharge times and improved bed utilization.