Identifying Core Functions and Forms of "Discharge by Noon" Interventions

Background: Many hospitals have implemented Discharge by Noon (DBN) programs to improve hospital throughput but have had mixed results.

Objective: Use a complex health intervention framework to define core functions and forms of DBN interventions.

Design: Qualitative study combined with scoping review.

Setting: Two hospitals in Michigan, USA.

Participants: Multidisciplinary stakeholders (n = 22) involved in the development and implementation of a DBN program.

Measurements: We conducted (1) stakeholder surveys and (2) a scoping review of the DBN literature. We integrated quantitative and qualitative data to develop a DBN functions and forms matrix.

Results: Qualitative thematic analysis of the stakeholder survey identified six core functions addressing five motivating needs for a DBN program, and the scoping review identified one additional core function addressing one additional motivating need. We identified 17 eligible studies for the scoping review, of which 15 (88%) found an improvement in DBN associated with the intervention and two (12%) did not. Compared with ineffective interventions, a greater proportion of effective ones enabled multi-disciplinary participation (76% vs 0%), provided a structured platform for communication (65% vs 0%), and enabled pre-identification of patients (59% vs 0%). Cross-case analysis revealed that programs that included either enablement of multi-disciplinary participation or structured platform for communication covered 100% of effective interventions and no ineffective ones.

Conclusion: Successful DBN programs include specific core functions. Our findings can guide system recommendations about optimal DBN intervention structures to maximize effectiveness and resource stewardship.