title: Natural history of late discharges from a general medical ward.
abstract: BACKGROUND
  Slow hospital discharges reduce efficiency and compromise care for patients awaiting a bed. Although efficient discharge is a widely held goal, the natural history of the discharge process has not been well studied.
  
  
  OBJECTIVE
  To describe the discharge process and identify factors associated with longer and later discharges.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A general medicine ward without house-staff coverage, in a tertiary care hospital (The Johns Hopkins Hospital) in Baltimore, Maryland, from January 1, 2005 to April 30, 2005.
  
  
  METHODS
  Two hundred and nine consecutively discharged adult inpatients.
  
  
  METHODS
  Discharge time (primary outcome) and discharge duration (secondary outcome).
  
  
  RESULTS
  Median discharge time was 3:09 PM (25th% to 75th%: 1:08 to 5:00 PM). In adjusted analysis, discharge time was associated with ambulance used on discharge (1.5 hours), prescriptions filled prior to discharge (1.4 hours), subspecialty consult prior to discharge (1.2 hours), and procedure prior to discharge (1.1 hours). Median duration of the discharge process was 7 hours 34 minutes (25th% to 75th%: 4.0 to 22.0 hours). Discharge duration was associated with discharge to a location other than home (28.9 hours), and with need for consultation (14.8 hours) or a procedure (13.4 hours) prior to discharge (all P values <0.05).
  
  
  CONCLUSIONS
  Discharge time and duration have wide variability. Longer and later discharges were associated with procedures and consults. Successful efforts to decrease time of discharge will require broad institutional effort to improve delivery of interdepartmental services.
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, 150 S.Huntington Ave., Boston, MA 02130, USA. lmchen@partners.org
authors.forename: Lena M
authors.initials: LM
authors.lastname: Chen
authors.forename: Michael H
authors.initials: MH
authors.lastname: Freitag
authors.forename: Manuel
authors.initials: M
authors.lastname: Franco
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Sullivan
authors.forename: Conan
authors.initials: C
authors.lastname: Dickson
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D010564:Personnel, Hospital; D044469:Racial Groups; D012947:Social Work; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D055815:Young Adult