Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record

Area of Science:

• Health Informatics
• Quality Improvement
• Patient Flow Management

Background:

• Effective hospital discharge relies on multidisciplinary coordination to optimize patient flow and outcomes.
• Insufficient coordination negatively impacts resource utilization and post-discharge care.
• A prospective, multidisciplinary discharge timing designation was developed for electronic health records (EHR).

Purpose of the Study:

• To implement a novel EHR-based discharge timing designation.
• To evaluate the association between this designation and actual discharge timing.

Main Methods:

• A quality improvement study utilized a confirmed discharge time (CDT) designation within the EHR.
• The CDT involved joint development by healthcare teams and patient families.
• Plan-do-study-act cycles, including provider education and EHR modification, were employed. Statistical process control charts monitored CDT use and before-noon discharges; length of stay served as a balancing measure.

Main Results:

• Over 20,000 pediatric discharges were analyzed from April 2013 to March 2017.
• Confirmed discharge time (CDT) use increased significantly from 0% to 62% post-implementation.
• The proportion of discharges before noon rose by 6.2 percentage points (19.9% to 26.1%), and mean length of stay decreased (47 to 43 hours).

Conclusions:

• Prospective, multidisciplinary EHR discharge time designation correlates with increased before-noon discharges.
• Further research should focus on replicating these findings in diverse settings.
• Identifying patient populations most responsive to discharge coordination efforts is a key next step.