Background: Unnecessary delays in patient discharges can lead to overcrowding, redundant handoffs, and increased inpatient unit and Emergency Department lengths of stay. Therefore, timely discharge of ready patients is essential to optimizing patient flow. Our hospital continued to see a large number of afternoon discharges from Medicine units despite employing multidisciplinary rounds and afternoon discharge huddles.
Purpose: Our objective was to identify a strategy to increase the percentage of discharges before noon from Medicine floors at a large urban academic hospital from a baseline of 9% to an institutional goal of 15%. We sought an approach for targeting early hospital discharges that would utilize multidisciplinary involvement, maximize staff engagement and employ routine use of meaningful performance data.
Description: We undertook a multi-factorial intervention on two Medicine Units from January – September 2015. Relevant discharge data were monitored daily and compared to pre-intervention performance data during weekly multi-disciplinary review meetings on those Medicine Units. In addition to routine review of performance data, interventions included: daily documentation of reasons for discharges after 12:00 pm; detailed “mini root-cause analyses” of avoidable late-day discharges; enhanced discipline-specific accountability for meeting discharge time targets; and real time Clinical Nurse Manager and Medical Director intervention to address barriers to timely discharges. Pre- and post-intervention analyses were conducted for percent discharges before 12 noon and median discharge time.
Conclusions: Data for comparable time periods in 2014 and 2015 revealed significant improvement in the percentage of patients discharged by 12:00 pm on both teaching and non-teaching floors (9.61% to 19.96%, p = .000 and 8.36% to 24.36%, p = .000) and earlier median discharge times (31-34 minutes earlier, p = .000). There was no adverse impact on observed-to-expected length of stay or 30-day readmission rates.
We achieved statistically-significant improvements in discharge-related performance on teaching and non-teaching Medicine units by instituting practices that: required routine unit-based data review; categorized and quantified reasons for discharges after 12:00 pm; increased real time interventions addressing discharge barriers; fostered multidisciplinary collaboration; and clarified discipline-specific accountability for unique contributions to the discharge process.