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Discharge Time of Day and 30-day Hospital Reutilization at an Academic Children's Hospital
Jimin Lee1,2,3, Melissa J Fazzari3, Michael L Rinke1,3
1Division of Pediatric Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York.
Insights
Children discharged in the evening have a higher 30-day hospital readmission rate compared to morning discharges. This study highlights the importance of discharge timing for pediatric patient outcomes.
Area of Science:
- Pediatric healthcare outcomes
- Hospital operations and patient flow
Background:
- Pediatric hospital discharge is a complex process impacting patient outcomes.
- Morning discharges are operationally preferred, but their effect on outcomes is not well understood.
- The association between discharge time of day and 30-day hospital reutilization requires further investigation.
Purpose of the Study:
- To assess if evening pediatric hospital discharges are associated with higher 30-day hospital reutilization rates compared to morning or afternoon discharges.
- To analyze the impact of discharge timing on pediatric patient readmission rates.
Main Methods:
- Retrospective cohort study of pediatric hospital discharges from July 2016 to December 2019.
- Discharges categorized into morning, afternoon, and evening groups.
- Multivariable modified least-squares regression used to compare 30-day all-cause hospital reutilization rates, adjusting for patient demographics and clinical factors.
Main Results:
- A total of 24,994 discharges were analyzed: 24.4% morning, 55.2% afternoon, 20.4% evening.
- Unadjusted 30-day reutilization rates were 14.1% (morning), 18.2% (afternoon), and 19.3% (evening).
- Adjusted 30-day reutilization rates were lowest for morning discharges (6.1%) compared to afternoon (9.0%) and evening (10.1%).
Conclusions:
- Evening pediatric discharges are linked to significantly higher adjusted 30-day all-cause hospital reutilization rates than morning discharges.
- No significant difference in reutilization rates was found between afternoon and evening discharges.
- Discharge timing is a critical factor influencing pediatric patient readmission risk.
Background:
Pediatric hospital discharge is a complex process. Although morning discharges are operationally preferred, little is known about the association between discharge time of day and discharge outcomes. We assessed whether children discharged from the hospital in the evening have a higher 30-day hospital reutilization rate than those discharged in the morning or afternoon.
Methods:
We conducted a retrospective cohort study on discharges from a children's hospital between July 2016 and December 2019. The cohort was divided into morning, afternoon, and evening discharges. Multivariable modified least-squares regression was used to compare 30-day all-cause hospital reutilization rates between morning, afternoon, and evening discharges while adjusting for demographic and clinical characteristics.
Results:
Among 24 994 hospital discharges, 6103 (24.4%) were in the morning, 13 786 (55.2%) were in the afternoon, and 5105 (20.4%) were in the evening. The unadjusted 30-day hospital reutilization rates were 14.1% in children discharged in the morning, 18.2% in children discharged in the afternoon, and 19.3% in children discharged in the evening. The adjusted 30-day hospital reutilization rate was lowest in the morning (6.1%, 95% confidence interval [CI] 4.1%-8.2%), followed by afternoon (9.0%, 95% CI 7.0%-11.0%) and evening discharges (10.1%, 95% CI 8.0%-12.3%). Morning discharge had a significantly lower adjusted 30-day all-cause hospital reutilization rate compared with evening discharge (P < .001), whereas afternoon and evening discharges were not significantly different (P = .06).
Conclusions:
The adjusted 30-day all-cause hospital reutilization rate was higher for evening discharges compared with morning discharges, whereas the rate was not significantly different between afternoon and evening discharges.
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