Implementing and Evaluating a Discharge Before Noon Initiative in a Large Tertiary Care Urban Hospital

Area of Science:

• Healthcare Management
• Hospital Operations
• Patient Flow Optimization

Background:

• Discharging patients before noon may improve hospital efficiency and reduce emergency department (ED) boarding.
• The effectiveness of a discharge before noon (DBN) initiative was evaluated to understand its impact on hospital operations.

Purpose of the Study:

• To assess the impact of a DBN initiative on patient discharge times.
• To determine if DBN affects hospital length of stay (LOS) and 30-day readmission rates.
• To analyze the influence of DBN on emergency department (ED) boarding times.

Main Methods:

• A retrospective pre-post study design was employed over 12-month periods.
• The DBN initiative included process refinements like daily rounds integration, electronic tracking, and expedited services.
• Statistical analyses included Kaplan-Meier estimates, log-rank tests, and accelerated failure time (AFT) modeling.

Main Results:

• The percentage of patients discharged before noon significantly increased from 5.0% to 11.4% post-initiative (p < 0.001).
• AFT analysis revealed that DBN patients experienced 41.5% earlier discharge times (p < 0.001).
• DBN was not independently associated with LOS or 30-day readmissions, but median ED boarding time increased by 41 minutes (p < 0.001).

Conclusions:

• The DBN initiative successfully increased the proportion of patients discharged before noon.
• Further research is required to develop strategies that enhance discharge timeliness while mitigating adverse effects on ED boarding times.