Background: Hospitals are required to give Medicare patients who are hospitalized for more than 2 days the “Important Message from Medicare” or IMM which includes information about discharge appeals and must do so no less than 4 hours before discharge. We hypothesized that giving more notice to a vulnerable patient population might improve patient outcomes. Evidence exists that discharge interventions such as patient education can lead to reduced readmission rates, but no literature could be found on outcomes with timing of discharge notice. We used a structured order in the electronic medical record and examined outcomes of readmission rates and length of stay based on lead time to discharge notice in a cohort of patients discharged home with services.

Methods: In November 2024, hospitalist teams were asked to focus on giving patients and caregivers 24-48h discharge notice for patients with a LOS of two days or longer. The primary attending and physician assistants were coached to use the EMR order Implement DC Plan or “IDP” after instructing the patient or caregiver that discharge was planned in the next 1-2 days. The nurse would then give the “IMM” form to the patient or call the caregiver to review it over the phone. The patient and caregiver could then begin an appeals process if desired. Non-Medicare patients would also receive the same process. Physicians were asked to place these reminders in their progress notes templates, EMR tools about milestone discharges were used to send reminders to the team as well.

Results: We analyzed data for patients who had a LOS of 2-30 days and who were discharged home with home services to capture a group that theoretically would benefit most from notice. Using the above methodology, we increased the rate of IDP orders from 72% in 2024 (2,890 patients) to 85% YTD Oct 2025 (3,751 patients). Discharge notice for patients within one calendar day of discharge increased from 64% to 75% and notable for a reduction in the readmission rate from 10.29% to 8.2% which did not meet statistical significance. Relative risk: 0.80 (95% CI 0.60 to 1.07)Patients with 1-2 days’ notice were increased from 35% to 50% from 2024 to 2025 with a reduction in readmissions in the latter group from 7.25% to 5.48%; however, this didn’t meet statistical significance (RR 0.76 (95% CI 0.53 to 1.08). We noted no change in the rate of IDP orders greater than 2 days from discharge with similar rates in 2024 and 2025 YTD of 16% more than 2 days from discharge and 4.5% more than 3 days from discharge. There was also no change in the readmission rates in these two groups with 2.6% and 0.8% respectively both years. There was also no impact to LOS with this intervention when comparing either timing of discharge notice or if an IDP was issued versus not despite the hospital LOS going down. The hospital readmission rate from 2024 to 2025 went down from 11% to 9.35% which was highly statistically significant, relative risk: 0.085 (95% CI 0.060 to 0.120) which appears attributable to another cause.

Conclusions: Our findings suggest that timing of discharge notice doesn’t appear to have an impact on LOS or readmission rates in a vulnerable patient. More analyses of subgroups will be analyzed to see if any patient group would benefit from extra discharge notice. We will also analyze time to discharge appeals as a next step and survey members of the interdisciplinary team to see if this intervention improves their workflows.