title: A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon.
abstract: OBJECTIVE
  The aim of this study is to evaluate the effect of 2 hospital-wide interventions on achieving a discharge-before-noon rate of 40%.
  
  
  BACKGROUND
  A multidisciplinary team led by administrative and physician leadership developed a plan to diminish capacity constraints by minimizing late afternoon hospital discharges using 2 patient flow management techniques.
  
  
  METHODS
  The study was a preintervention/postintervention retrospective analysis observing all inpatients discharged across 19 inpatient units in a 484-bed, academic teaching hospital measuring calendar month discharge-before-noon percentage, patient satisfaction, and readmission rates. Patient satisfaction and readmission rates were used as baseline metrics.
  
  
  RESULTS
  The discharge-before-noon percentage increased from 14% in the 11-month preintervention period to an average of 24% over the 11-month postintervention period, whereas patient satisfaction scores and readmission rates remained stable.
  
  
  CONCLUSIONS
  Implementation of the 2 interventions successfully increased the percentage of discharges before noon yet did not achieve the goal of 40%. Patient satisfaction and readmission rates were not negatively impacted by the program.
authors.affiliation: Author Affiliations: Executive Director (Ms Kane), Performance Excellence & Medicine Services; Administrative Director (Mr Arthofer), Hospital Operations Center, Administration; Administrative Director (Mr Seay-Morrison), Clinical Support Services, Patient Care Services; Visualization Developer (Mr Elfman), Clinical and Business Analytics; Project Manager (Mr Ramirez), Performance Excellence; Director of Research (Dr Pickham), Patient Care Services; and Chief Operations Officer (Mr Hereford), Administration, Stanford Health Care, Menlo Park; and Vice Chair of Medicine (Dr Weinacker), Quality Implementation, Department of Medicine; Clinical Associate Professor (Dr Ahuja), Medicine; and Professor and Chief (Dr Welton), Colon & Rectal Surgery, Stanford University School of Medicine, California.
authors.forename: Marlena
authors.initials: M
authors.lastname: Kane
authors.forename: Ann
authors.initials: A
authors.lastname: Weinacker
authors.forename: Rudolph
authors.initials: R
authors.lastname: Arthofer
authors.forename: Timothy
authors.initials: T
authors.lastname: Seay-Morrison
authors.forename: Wesley
authors.initials: W
authors.lastname: Elfman
authors.forename: Mark
authors.initials: M
authors.lastname: Ramirez
authors.forename: Neera
authors.initials: N
authors.lastname: Ahuja
authors.forename: David
authors.initials: D
authors.lastname: Pickham
authors.forename: James
authors.initials: J
authors.lastname: Hereford
authors.forename: Mark
authors.initials: M
authors.lastname: Welton
mesh_terms: D057191:Capacity Building / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D017598:Efficiency, Organizational; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007324:Institutional Management Teams / Q000458:organization & administration* / Q000592:standards; D033183:Interdisciplinary Communication; D019982:Organizational Case Studies; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D013997:Time Factors; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration / Q000592:standards