Discharge before noon: an achievable hospital goal.
BACKGROUND
Late afternoon hospital discharges are thought to contribute to admission bottlenecks, overcrowding, and increased length of stay (LOS). In January 2012, the discharge before noon (DBN) percentage on 2 medical units was 7%, below the organizational goal of 30%.


OBJECTIVE
To sustainably achieve a DBN rate of 30% and to evaluate the effect of this intervention on observed-to-expected (O/E) LOS and 30-day readmission rate.


METHODS
Pre-/post-intervention retrospective analysis.


METHODS
Two acute care inpatient medical units in an urban, academic medical center.


METHODS
All inpatients discharged from the units.


METHODS
All staff helped create a checklist of daily responsibilities at a DBN kickoff event. We initiated afternoon interdisciplinary rounds to identify next-day DBNs and created a website for enhanced communication. We provided daily feedback on the DBN percentage, rewards for success, and real-time opportunities for case review.


METHODS
Calendar month DBN percentage, O/E LOS, and 30-day readmission rate.


RESULTS
The DBN percentage increased from 11% in the 8-month baseline period to an average of 38% over the 13-month intervention (P = 0.0002). The average discharge time moved 1 hour and 31 minutes earlier in the day. The O/E LOS declined from 1.06 to 0.96 (P = 0.0001), and the 30-day readmission rate declined from 14.3% to 13.1% (P = 0.1902).


CONCLUSIONS
Our study demonstrates that increased DBN is an achievable and sustainable goal for hospitals. Future work will allow for better understanding of the full effects of such an intervention on patient outcomes and hospital metrics.
Department of Medicine, New York University Langone Medical Center, New York, New York.
Benjamin
B
Wertheimer
Ramon E A
RE
Jacobs
Martha
M
Bailey
Sandy
S
Holstein
Steven
S
Chatfield
Brenda
B
Ohta
Amy
A
Horrocks
Katherine
K
Hochman
D000046:Academic Medical Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D057189:Checklist; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009042:Motivation; D009937:Organizational Objectives; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors