Background: Throughput is an issue that is discussed often in hospitals around the country. Multiple factors influence the time the discharge orders are placed to the time the patient leaves the hospital. In academic centers, teaching rounds tend to occur in the morning, which means the actual discharge order does not get put in until after rounds and many times after noon conference. The delay in the discharge order entry time is thought to hold up the actual discharge of the patient so the room is not ready in time for the next patient. We aimed to assess if pending the discharges the day prior to discharge would allow for an earlier discharge order time and subsequent improved throughput as the patient would leave the hospital sooner.
Methods: We prospectively looked at four of our general internal medicine teams and divided them into a control group and a variable group. The variable group would pend discharges the day before. To pend a discharge meant completing, but not signing, the discharge medication reconciliation form and the discharge order the day before a suspected discharge. The study went from January 1, 2016 to March 31, 2016. We collected data on which patients had pended discharges, the time of the EMR discharge order, and the time it took from the discharge order being placed to the time the patient left the hospital. We excluded patients whose length of stay was less than 24 hours as pending discharges on these patients may not have been possible.
Results: We identified a total of 817 cases in which the control group had 404 while the variable group had 413 cases. Out of all of the cases, only 102 of them had pended discharges the day before. We found that the order for discharge time was earlier when discharge orders were pended the night before. The difference between the pended (102) vs non-pended (715) groups is almost 47 minutes with a p = 3.75×10-4 (Figure 1). The difference in discharge order time between the variable and control groups was also significantly affected with a difference of 30 minutes (p=0.003) Unexpectedly, we found that the earlier the discharge order was placed, the longer it took for the patient to be discharged. (Figure 2)
Conclusions: A pilot study was done to see if pending discharges the day before would allow patients to be discharged earlier. Through our interventions, we were able to prove discharge order times can be entered earlier if discharge paperwork was pended the day before. As many factors can influence the discharge process, we now know that we need to continue to work on them in order to expedite the discharge process.
To cite this abstract:Choksi, H; Robertson, N; Upadhyayula, S; Kothari, N; Schmitz, P . IMPACT OF PENDING DISCHARGES THE DAY BEFORE ON THROUGHPUT. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 149. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-pending-discharges-the-day-before-on-throughput/. Accessed April 1, 2020.