Original Article

Discharge Rounds: Implementation of a Targeted Intervention for Improving Patient Throughput on an Inpatient Medical Teaching Service

Authors: Krisda H. Chaiyachati, MD, MPH, Andre N. Sofair, MD, MPH, Jeremy I. Schwartz, MD, David Chia, MD, MSc


Objectives: Patient throughput and early discharges are important for decreasing emergency department wait times and creating available beds for new hospital admissions. The educational schedule of internal medicine trainees can interfere with timely discharges, but targeted interventions can help residents meet the hospital’s patient flow needs. Our training program instituted daily morning discharge rounds on the inpatient service, requiring each team to prepare potential discharges 1 day ahead and prioritizing these discharges the next day.

Methods: We conducted a retrospective, pre–post analysis 1 month before and 3 months after implementation in August 2013 to assess discharge order entry times, the proportion of discharges before 11:00 am, and hospital departure times.

Results: One month post-implementation, discharge orders were entered 59 minutes earlier (from 1:07 pm to 12:08 pm; P  = 0.001), the percentage of pre-11:00 am discharges increased from 21% to 39% ( P  < 0.01), and patients departed the hospital 50 minutes earlier (from 3:21 pm to 2:31 pm; P  = 0.005). These effects, however, returned to pre-implementation times during the subsequent 2 months.

Conclusions: A targeted intervention can significantly improve early discharges and should be replicable at other academic medical centers. Reinforcement is needed for these gains to be sustainable, however.

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1. Handel DA, French LK, Nichol J, et al. Associations between patient and emergency department operational characteristics and patient satisfaction scores in an adult population. Ann Emerg Med 2014;64:604-608.
2. Powell ES, Khare RK, Venkatesh AK, et al. The relationship between inpatient discharge timing and emergency department boarding. J Emerg Med 2012;42:186-196.
3. Wertheimer B, Jacobs RE, Bailey M, et al. Discharge before noon: an achievable hospital goal. J Hosp Med 2014;9:210-214.
4. Jweinat J, Damore P, Morris V, et al. The safe patient flow initiative: a collaborative quality improvement journey at Yale-New Haven Hospital. Jt Comm J Qual Patient Saf 2013;39:447-459.
5. Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements. https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Published July 1, 2013. Accessed February 29, 2016.
6. Kravet SJ, Levine RB, Rubin HR, et al. Discharging patients earlier in the day: a concept worth evaluating. Health Care Manag (Frederick) 2007;26:142-146.
7. Young JQ, Ranji SR, Wachter RM, et al. ‘‘July effect’’: impact of the academic year-end changeover on patient outcomes: a systematic review. Ann Intern Med 2011;155:309-315.
8. O’Mahony S, Mazur E, Charney P, et al. Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med 2007;22:1073-1079.
9. Fine JM, Fine MJ, Galusha D, et al. Patient and hospital characteristics associated with recommended processes of care for elderly patients hospitalized with pneumonia: results from the medicare quality indicator system pneumonia module. Arch Intern Med 2002;162:827-833.
10. Wachter B. Average time of discharge: why a hospital is not a Hilton. http://community.the-hospitalist.org/2008/03/26/average-time-of-discharge-why-a-hospital-is-not-a-hilton. Published March 26, 2008.Accessed February 29, 2016.