Background: Persistently high hospital volumes, increased patient complexity, and lack of skilled nursing bed availability have led to significant bottlenecks in care and decreased inpatient bed availability. A hospital-wide initiative was created to increase the rate of discharge before noon (DBN). To meet discharge targets on hospital medicine units, we formed a multidisciplinary quality improvement [...]

Background: At our institution, late discharge times and low rates of discharge before noon (DBN) have historically been associated with bottlenecks and delays in patient care. During the COVID-19 pandemic, changes in hospital census and staffing further increased the need for efficient and safe patient discharges. To address these barriers, we formed a multidisciplinary quality [...]

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 [...]

Background: While hospitals are primarily designed to provide acute care, a subset of patients have prolonged lengths of stay beyond medical necessity for months on general medicine wards[1]. These cases often occur in vulnerable patient populations, including those with mental health and substance use disorders[2], impaired decision-making capacity[3, 4], and housing insecurity[3]. However, few studies [...]

Background: The hospital discharge represents a time-dependent and vulnerable chapter in the patient pathway. Approximately one-fifth of hospital discharges suffer delays due to non-medical reasons with one major factor being inadequate assessment and recognition of barriers to discharge when first admitted. Promising work in the existing literature demonstrates a relationship between a measure of patient’s [...]

Background: Patients hospitalized with COVID-19 can clinically deteriorate in the second week of illness after a period of initial stability. Thus, an important clinical question is determining when it is safe to discharge these patients from the hospital without overwhelming hospitals’ capacities. Unfortunately, discharge criteria for COVID-19 patients are often based on expert opinion, with [...]

Background: Previous studies have documented discriminatory refusals from post-acute care facilities related to opioid use disorder or opioid agonist therapy, however the impact of inability to secure skilled nursing facility (SNF) placement for patients with any substance use disorder (SUD) has not been fully explored. The objective of this study is to measure the odds [...]