Discharge before noon: Effect on throughput and sustainability

Wertheimer, Benjamin; Jacobs, Ramon E. A.; Iturrate, Eduardo; Bailey, Martha J.; Hochman, Katherine

doi:10.1002/jhm.2412

Cited by 46 publications

(59 citation statements)

References 11 publications

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“…To quantify throughput, hospitals are beginning to measure the proportion of patients discharged before noon (DCBN). One study, looking at discharges on a single medical floor in an urban academic medical center, suggested that increasing the percentage of patients discharged by noon decreased observed‐to‐expected LOS in hospitalized medicine patients, and a follow‐up study demonstrated that it was associated with admissions from the emergency department occurring earlier in the day . However, these studies did not adjust for changes in case mix index (CMI) and other patient‐level characteristics that may also have affected these outcomes.…”

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confidence: 99%

“…One study, looking at discharges on a single medical floor in an urban academic medical center, suggested that increasing the percentage of patients discharged by noon decreased observed-toexpected LOS in hospitalized medicine patients, 3 and a follow-up study demonstrated that it was associated with admissions from the emergency department occurring earlier in the day. 4 However, these studies did not adjust for changes in case mix index (CMI) and other patient-level characteristics that may also have affected these outcomes. Concerns persist that more efforts to discharge patients by noon could inad-vertently increase LOS if staff chose to keep patients overnight for an early discharge the following day.…”

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confidence: 99%

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The association between discharge before noon and length of stay in medical and surgical patients

Rajkomar

Valencia

Novelero

et al. 2015

Journal of Hospital Medicine

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BACKGROUND Discharging patients before noon is a key approach to improving bed utilization. Few data exist to describe whether patients are discharged earlier or their stay is extended to allow for an early discharge the next day. OBJECTIVE To determine if a discharge before noon (DCBN) is associated with length of stay (LOS). DESIGN/SETTINGS/PATIENTS Retrospective analysis of data from adult medical and surgical discharges from a single academic center from July 2012 through April 2015. We used a multivariable generalized linear model to evaluate the association between DCBN and LOS. RESULTS Of 38,365 hospitalizations, 6484 (16.9%) were discharged before noon, and the median LOS was 3.7 days. After adjustment, DCBN was associated with a longer LOS (adjusted odds ratio [OR]: 1.043, 95% confidence interval [CI]: 1.003‐1.086). The association between longer LOS and DCBN was more pronounced in patients admitted emergently (n = 14,192, 37%) (adjusted OR: 1.14, 95% CI: 1.033‐1.249). CONCLUSIONS Although we cannot discern whether discharges were delayed to achieve discharge before noon, earlier discharge was associated with a longer LOS, particularly among emergent admissions. Journal of Hospital Medicine 2015;11:859–861. © 2015 Society of Hospital Medicine

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confidence: 99%

mentioning

confidence: 99%

The association between discharge before noon and length of stay in medical and surgical patients

Rajkomar

Valencia

Novelero

et al. 2015

Journal of Hospital Medicine

View full text Add to dashboard Cite

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“…In addition, this study builds upon Wertheimer's results as although they later assessed the timing of ED admissions as a result of their EDC improvements, they did not directly assess inpatient bed wait times as we did in our study. 14 As providers of all types were aware of the constant push for beds due to canceled surgeries, delayed admissions and intensive care transfers, and the inability to accept admission, it is difficult to compare the subgroups directly. Furthermore, although physician teams and units are distinct, individuals (nurses, case managers, trainees) may rotate through different units and teams and we cannot account for individual influences on EDCs depending on exposure to interventions over time.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] A number of recent im-provement efforts directed at moving discharges earlier in the day have been published. [10][11][12][13][14][15] However, these improvements are often targeted at specific units or teams within a larger hospital setting and only one is in the pediatric setting.…”

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confidence: 99%

Improving Patient Flow: Analysis of an Initiative to Improve Early Discharge

Destino

Bennett

Wood

et al. 2019

Journal of Hospital Medicine

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BACKGROUND: Discharge delays adversely affect hospital bed availability and thus patient flow. OBJECTIVE: We aimed to increase the percentage of early discharges (EDCs; before 11 am). We hypothesized that obtaining at least 25% EDCs would decrease emergency department (ED) and postanesthesia care unit (PACU) hospital bed wait times. DESIGN: This study used a pre/postintervention retrospective analysis. SETTING: All acute care units in a quaternary care academic children's hospital were included in this study.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Sharma

Wong

Arnaoutakis

et al. 2017

Journal of Vascular Surgery

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Objectives Length of stay fails to completely capture the clinical and economic effects of patient progression through the phases of inpatient care, such as admission, room placement, procedures, and discharge. Delayed hospital throughput has been linked to increased time spent in the emergency department and post-anesthesia care unit, delayed time to treatment, increased inhospital mortality, decreased patient satisfaction, and lost hospital revenue. We identified barriers to vascular surgery inpatient care progression and instituted defined measures to positively impact standardized metrics. Methods The study was divided into three periods: pre-intervention, “wash-in”, and post-intervention. During the pre-intervention phase, barriers to patient flow were quantified by an interdisciplinary team. Suboptimal provider communication emerged as the key barrier. An enhanced communication intervention consisting of face-to-face and mobile application-based education on key patient flow metrics, explicit discussion of individual patient barriers to progression at rounds and interdisciplinary huddles, and communication of projected discharge and potential barriers via e-mail was developed with input from all stakeholders. Following a four-week wash-in implementation phase, data collection was repeated. Results The pre- and post-intervention patient cohorts accounted for 244.3 and 238.1 inpatient days, respectively. Both groups had similar baseline demographic, clinical characteristics, and procedures performed during hospitalization. The post-intervention group was discharged 78 minutes earlier (14:00:32 versus 15:18:37, P=0.03) with a trend toward increased discharge by noon (94% versus 88%, P=0.09). Readmission rates did not differ (P=0.44). Conclusions Implementation of a focused, interdisciplinary, frontline provider-driven, enhanced communication program can be feasibly incorporated into existing specialty surgical workflow. The program resulted in improved timeliness of discharge and projected cost savings, without increasing readmission rates.

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Discharge before noon: Effect on throughput and sustainability

Abstract: Increasing the DBN rate correlates with admissions arriving earlier in the day and reductions in high-frequency peaks of ED admissions. Statistically significant improvements in DBN rates are sustainable.

Cited by 46 publications

References 11 publications

The association between discharge before noon and length of stay in medical and surgical patients

The association between discharge before noon and length of stay in medical and surgical patients

Improving Patient Flow: Analysis of an Initiative to Improve Early Discharge

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

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