Discharge before noon: Effect on throughput and sustainability.

Area of Science:

• Healthcare Operations
• Hospital Management
• Patient Flow Optimization

Background:

• Late afternoon hospital discharges contribute to admission bottlenecks.
• An intervention successfully increased the discharge before noon (DBN) rate on two inpatient medicine units.

Purpose of the Study:

• To evaluate the effect of an increased DBN rate on admission arrival times and hourly admission numbers.
• To assess the sustainability of the DBN initiative.

Main Methods:

• Retrospective analysis of pre-/postintervention data from two acute-care inpatient medicine units.
• Data included patient arrival and discharge times from June 2011 to December 2014.
• A multidisciplinary intervention aimed to increase the DBN rate.

Main Results:

• A statistically significant shift in median admission arrival time from 5 PM to 4 PM.
• Significant reduction in high-frequency admission peaks for emergency department (ED) admissions.
• Sustained statistically significant increase in the DBN rate, reaching 35%.

Conclusions:

• Increasing the DBN rate correlates with earlier patient arrivals and reduced admission peaks.
• The improvements in DBN rates achieved through the intervention are sustainable.
• Optimizing discharge timing can positively impact hospital admission flow.