Discharge before noon: An achievable hospital goal

Abstract

BACKGROUND Late afternoon hospital discharges are thought to contribute to admission bottlenecks, overcrowding, and increased length of stay (LOS). In January 2012, the discharge before noon (DBN) percentage on 2 medical units was 7%, below the organizational goal of 30%. OBJECTIVE To sustainably achieve a DBN rate of 30% and to evaluate the effect of this intervention on observed‐to‐expected (O/E) LOS and 30‐day readmission rate. DESIGN Pre‐/post‐intervention retrospective analysis. SETTING Two acute care inpatient medical units in an urban, academic medical center. PATIENTS All inpatients discharged from the units. INTERVENTION All staff helped create a checklist of daily responsibilities at a DBN kickoff event. We initiated afternoon interdisciplinary rounds to identify next‐day DBNs and created a website for enhanced communication. We provided daily feedback on the DBN percentage, rewards for success, and real‐time opportunities for case review. MEASUREMENTS Calendar month DBN percentage, O/E LOS, and 30‐day readmission rate. RESULTS The DBN percentage increased from 11% in the 8‐month baseline period to an average of 38% over the 13‐month intervention (P = 0.0002). The average discharge time moved 1 hour and 31 minutes earlier in the day. The O/E LOS declined from 1.06 to 0.96 (P = 0.0001), and the 30‐day readmission rate declined from 14.3% to 13.1% (P = 0.1902). CONCLUSIONS Our study demonstrates that increased DBN is an achievable and sustainable goal for hospitals. Future work will allow for better understanding of the full effects of such an intervention on patient outcomes and hospital metrics. Journal of Hospital Medicine 2014;9:210–214. © 2014 Society of Hospital Medicine

Barriers to timely discharge from the general medicine service at an academic teaching hospital

“…Family meetings and disposition planning occur throughout a patient's stay in the hospital. There is an effort at Stanford Hospital to discharge patients by noon based on evidence that early discharges help reduce patient capacity bottlenecks 14. Each member of the care team has a specific role in the discharge process that is described in table 2.…”

Systematic identification and management of barriers to vascular surgery patient discharge time of day

“…5 Previous reports have revealed that staff-led interventions can improve discharge times, and that timely discharge decreases emergency room and surgical boarding. 31, 38 While 78 minutes in isolation may not seem to be a meaningful improvement in discharge time, on a system level such modest, incremental gains have a substantial impact on patient flow through precious hospital resources. 5 …”

“…This initiative focused on newer metrics of throughput, such as specific time of discharge and discharge by noon. 7, 31, 32 Here we discuss how the vascular surgery division at our academic medical center utilized a systematic approach to identify barriers to efficient patient throughput and successfully implemented a patient flow intervention.…”

Facilitating Early-In-Day Discharge for Multiple Sclerosis Patients Treated With Intravenous Methylprednisolone

“…There was a trend toward an earlier median time of discharge, comparable to other EIDD interventions. 4,10 This increase in EIDD proportion occurred in the setting better coordination of discharge day activities, specifically early-in-day administration of the final methylprednisolone dose. Preparation for this early dose administration was made at time of admission through order entry using the developed intervention order set.…”