Early Discharge Clinic: A Quality Improvement Initiative to Create a Safe and Efficient Model for Intensive...

Intensive treatment regimens for hematologic malignancies often lead to prolonged hospitalizations, strained inpatient resources, and reduced quality of life. Standard outpatient clinic models are frequently unable to support early discharge for these high-acuity patients. To address this local care-delivery gap, Northwell Health established New York State's first Early Discharge Clinic (EDC). We herein describe EDC operationalization and initial outcomes and compare the average hospital length of stay (ALOS) with historical Northwell Health's EDC for Hematologic Malignancies controls.

This quality improvement initiative proposed a structured EDC for patients with hematologic malignancies enrolled in 2023 and 2024. Eligible patients were identified during inpatient admissions and selected for early discharge based on clinical stability, supportive care needs, and logistical readiness for frequent outpatient follow-up. The EDC incorporated nine operational pillars supporting high-acuity outpatient care. Performance measures were selected to assess utilization (visit frequency, blood product utilization), timeliness of supportive care (time to antibiotic administration), safety (nonscheduled readmissions within 48 hours and 7 days after discharge, mortality), and efficiency (ALOS).

The program accrued 191 enrollments from 112 unique individuals. Patients received a median of five structured evaluations, and most required blood product support. Neutropenic fever occurred in 36 of 191 enrollments; the median time to antimicrobial administration was 46 minutes (range, 6-131 minutes). There were no unplanned readmissions within 48 hours of discharge, and 11 within 7 days. No outpatient mortality occurred. EDC implementation reduced ALOS by 10.2 days, corresponding to a 39.7% reduction (P = .00025).

The EDC demonstrated a safe and effective model for early outpatient management of selected patients undergoing therapy for hematologic malignancies. These findings support the EDC as a practical framework for improving efficiency and reducing hospitalization while maintaining timely high-acuity care.