Background: Improving hospital throughput is critical to optimizing patient flow and capacity, particularly during periods of high census and ED boarding which can adversely impact patient experience and have downstream safety implications. Prolonged length of stay may result from inadequate alignment among care team members on patients expected to discharge, insufficient communication of discharge barriers, and lack of standard roles for the completion of discharge tasks. To address these gaps, we developed an interprofessional, Clinical Assistant (CA)-led “Accelerated Discharge Program” (ADP) designed to improve communication regarding discharge timing, streamline coordination of discharge tasks, and promote earlier discharges for patients identified as likely to leave the hospital within 24 hours.
Methods: The ADP was implemented on our direct care Hospital Medicine service at a 600-bed academic tertiary care center. The service comprises 10 hospitalist teams who each care for up to 10 patients per day (up to 100 patients across the service) without resident physicians or advanced practice providers. The ADP was managed by a single CA responsible for providing administrative support to each of these teams who executed a standardized discharge planning workflow. Core components of this workflow (Figure 1) included (1) standardized outreach via secure text message to each direct care attending each Monday-Thursday afternoon to identify patients likely to be discharged the following day, (2) confirmation of outstanding tasks needed prior to discharge, and (3) facilitating the completion of tasks to promote an earlier discharge. To evaluate the program’s impact on hospital throughput, we analyzed changes in the average length of stay (LOS) on the direct care service compared to that of the Hospital Medicine teaching service which did not have a CA but managed the same population of patients.
Results: In the first year of the intervention (October 2023 to September 2024) the ADP involved 938 unique Hospital Medicine encounters (26% of 3,550 discharges). The direct-care service experienced a 0.6-day reduction in length of stay (LOS) in the first 12 months following the implementation, compared to a 0.1-day increase in LOS on the teaching service during the same period (Table 1). This reduction was sustained throughout the program’s first year, indicating a consistent impact of the intervention.
Conclusions: We developed a Clinical Assistant-led Accelerated Discharge Program focused on using proactive communication of anticipated discharges and discharge needs to improve hospital throughput and length of stay. The decrease in LOS coincided with the implementation of the program, suggesting proactive communication about discharge needs and task coordination may support hospitalists in earlier discharge planning.
