Increasing Early Inpatient Hospitalization Discharges

Delayed hospital discharges cause throughput issues that impact operating rooms and EDs serving patients requiring inpatient admission and account for millions of dollars in revenue loss. Baseline observational data collected over a seven-month period on an intermediate surgical unit showed that 12% of surgical inpatients were discharged by 12 PM even though 63% had been identified as ready for discharge with no clinical contingencies on morning rounds.

The purpose of this quality improvement initiative was to promote timely discharges on an inpatient intermediate surgical unit through use of a multidisciplinary team approach and visual, nonverbal communication.

Over the project period (March 2021 to November 2024), we used the DMAIC (define, measure, analyze, improve, and control) approach following Lean Six Sigma principles to engage those working on the surgical unit and improve communication and efficiency. Plan-Do-Study-Act cycles were employed to implement daily huddles with nursing staff and leadership, and a patient whiteboard magnet system was devised for visual, nonverbal communication. Data were collected through direct observation and electronic health record review to capture outcome variables.

Compared with baseline data collected from May 2019 showing that only 12% (n = 11) of 91 eligible patients were discharged by 12 PM, postintervention data from November 2024 showed that 43% (n = 54) of 127 eligible patients were discharged by 12 PM-an increase in the percentage of pre-noon discharges of 258%.

We found that visual, nonverbal cues and daily huddles improved early communication between physicians and nurses regarding a patient's discharge plan and increased the volume of patients discharged by 12 PM. Our findings can be used to improve or inform efforts to promote earlier discharge of surgical patients as well as those in other inpatient units.