Natural history of late discharges from a general medical ward.
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.
Chen
Lena M
LM
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, 150 S.Huntington Ave., Boston, MA 02130, USA. lmchen@partners.org
Freitag
Michael H
MH
Franco
Manuel
M
Sullivan
Christopher D
CD
Dickson
Conan
C
Brancati
Frederick L
FL
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