Making it Home on Time: Improving Child Neurology Inpatient Discharge Timing

OBJECTIVE: During the COVID-19 pandemic, healthcare systems have struggled to meet ever-increasing demands to accommodate patients and provide adequate medical care. Additionally, service models are shifting to increasingly incorporate patient satisfaction. One variable with impacts on efficiency and satisfaction is discharge timing. Delayed discharges may increase hospitalization costs and indirectly delay elective procedures. Existing data suggest an efficient workflow should safely discharge 20% of patients by 11:00am, though current U.S. averages range between 5-10%. At our institution, we found 0% of patients were discharged before 11:00am during 2nd quarter 2021. Our objective was to introduce a rounding intervention to improve our service’s discharge timing.

METHODS: A change was suggested based on resident feedback, wherein potential discharges were identified by our trainees during the day prior to discharge, and morning rounds moved to expedite these patients. All residents were instructed in the mechanics of this intervention and provided monthly updates. Metrics were gathered via chart review of service lists during 4th quarter 2021.

RESULTS: Prior to our intervention, 0% of discharges were completed prior to 11AM. Post intervention, 14.6% of discharges were completed during this timeframe. Additionally, 18.8% of patients were discharged prior to noon, and another 26% prior to 2PM.

CONCLUSION: Our intervention exceeded national averages, although we didn’t meet our target, the volume of patients discharged just after 11AM suggests further refinement could achieve this. We present this data to encourage the utility of simple modifications to improve quality metrics and engage trainees in systems and quality practice.
Keywords: discharges, patient satisfaction, resident engagement