21 Daily dynamic discharge - a whole system solution to ED crowding

Area of Science:

• Healthcare Management
• Hospital Operations
• Patient Flow Optimization

Background:

• Emergency Department (ED) crowding is linked to increased mortality, reduced patient/staff satisfaction, and longer stays.
• Exit block, a cause of ED crowding, necessitates system-wide patient management to align admissions and discharges.
• The Daily Dynamic Discharge (DDD) approach was implemented to increase early inpatient discharges and improve ED flow.

Purpose of the Study:

• To evaluate the effectiveness of the Daily Dynamic Discharge (DDD) approach in improving hospital patient flow.
• To reduce Emergency Department (ED) crowding by increasing the number of early inpatient discharges.
• To analyze the impact of DDD on discharge timing and length of stay.

Main Methods:

• Conducted training sessions on DDD implementation over two weeks with clinical and managerial staff.
• Instituted daily multidisciplinary whiteboard meetings and early Estimated Date of Discharge (EDD) determination.
• Implemented 'golden hour' ward rounds prioritizing high-acuity and soon-to-be-discharged patients.

Main Results:

• Average weekly discharges increased by 3.7 (from 26.5 to 30.2) over twelve weeks.
• Average length of stay decreased by 0.6 days (from 6.8 to 6.2 days).
• Median discharge time advanced by 32 minutes, with pre-4 pm discharges rising from 33% to 44%.

Conclusions:

• Effective ED flow requires sufficient early-day ward discharges to accommodate ED admissions.
• The DDD approach successfully increased early discharges, smoothed admission/discharge profiles, and is being adopted elsewhere.
• Optimizing discharge timing is crucial for managing hospital capacity and improving patient flow throughout the system.