title: A multidisciplinary care pathway significantly increases the number of early morning discharges in a large academic medical center.
abstract: In an environment where there is increased demand for hospital beds, it is important that inpatient flow from admission to treatment to discharge is optimized. Among the many drivers that impact efficient patient throughput is an effective and timely discharge process. Early morning discharge helps align inpatient capacity with clinical demand, thereby avoiding gridlock that adversely affects scheduled surgical procedures, diagnostic procedures, and therapies. At our large, academic medical center, we hypothesized that an interdisciplinary approach to scheduled discharge order entry would increase the percentage of discharges occurring before 11:00 AM and improve overall discharge time. The pilot study involved moving rate-limiting steps to earlier in the discharge process, specifically medication reconciliation to the night before discharge and "discharge to home" order entry before 9:00 AM the morning of discharge. The baseline rate of discharges before 11:00 AM was 8% and significantly increased to 11% after the intervention (P = .02). Moreover, in the subset of patients (21%) for whom early medication reconciliation and discharge to home order entry were both executed, the percentage of patient discharges occurring before 11:00 AM increased to 29.7%, with an associated average discharge time of more than 3 hours earlier. No patient harm events were associated with this pilot project. There was no significant change in length of stay, and 30-day readmission rate improved significantly from 13.8% to 10.3% (P = .002). Our study demonstrates that a multidisciplinary approach using prescribed order entry and medication reconciliation is a low cost, safe, and effective way to increase early morning discharges and improve patient flow for large hospitals with high volumes of scheduled patient admissions.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA (Drs Durvasula, Staiger, and Anawalt); Transformation of Care Department, UW Medicine Health System, Seattle, WA (Mr Kayihan); Patient Care Services (Mss Del Bene and Parker), Center for Clinical Excellence (Mr Granich), University of Washington Medical Center, Seattle, WA.
authors.forename: Raghu
authors.initials: R
authors.lastname: Durvasula
authors.forename: Arkan
authors.initials: A
authors.lastname: Kayihan
authors.forename: Sherri
authors.initials: S
authors.lastname: Del Bene
authors.forename: Marion
authors.initials: M
authors.lastname: Granich
authors.forename: Grace
authors.initials: G
authors.lastname: Parker
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Anawalt
authors.forename: Thomas
authors.initials: T
authors.lastname: Staiger
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D057189:Checklist; D003266:Continuity of Patient Care / Q000458:organization & administration*; D017598:Efficiency, Organizational; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D007400:Interprofessional Relations; D007902:Length of Stay; D059065:Medication Reconciliation / Q000458:organization & administration; D010351:Patient Discharge; D010359:Patient Readmission; D010865:Pilot Projects