Investing in a New Role to Increase Timely Morning Discharges in the Inpatient Setting

Objective: Delays in discharges have a downstream effect on emergency department admissions, wait times, intensive care unit transfers, and elective admissions. This quality improvement project's aim was to increase the percentage of discharges before noon from a hospital medicine service from 19% to 30% over a 6-month period and sustain the increase for 6 months.

Methods: Interventions included introduction of a dedicated patient flow provider (PFP), optimization of workflow, technology assistance with discharge tasks, and multidisciplinary education on patient flow. The primary outcome was percentage of discharges before noon, and secondary outcome was length of stay (LOS). The process measure compared discharges before noon with and without the PFP. Additional equity and regression analyses were completed. The balancing measure was 7-day readmissions.

Results: Discharges before noon rose from baseline 19% to 34%. On days the PFP was present, discharges before noon were 43% vs 22% when not present. Rational subgrouping showed an initial and persistent disparity in discharges before noon for racial and ethnic minority patients and patients who use a language other than English (LOE). LOS remained stable from baseline 2.74 to 2.54 days. There was no change in 7-day readmission rate.

Conclusion: Discharges before noon significantly increased after the addition of a staff member dedicated to discharge tasks. Additional staffing represents a large investment, and additional studies are needed to quantify the financial impact of this intervention. Future targeted work to address persistent disparities in discharges before noon for racial and ethnic minority patients and those who use an LOE is also needed.