Driving in the Wrong Direction: Exploring the Unintended Consequence of an Early Discharge Program on Length of Stay in Hospital Setting.

IF 1.2 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Quality Management in Health Care Pub Date : 2024-07-18 DOI:10.1097/QMH.0000000000000466

Paul Hodges, Christopher A Linke, Johannah D Bjorgaard, Megan E Edgerton

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引用次数: 0

Abstract

Importance: Early discharge of patients has become standard work in acute care settings to reduce inpatient length of stay (LOS), improve patient flow, and reduce boarding in the emergency department (ED).

Objective: Retrospective analysis of outcomes from a discharge by 11 am program at an academic medical center from January 1, 2020, to June 30, 2022. The analysis addresses the effects of a discharge by 11 am goal on time from discharge order release to patient discharge, ED boarding, LOS, and observed-to-expected LOS.

Design, setting, and participants: Patient-level electronic health record data included discharge order entry time, discharge time, LOS, and diagnosis-related group geometric LOS (GMLOS). Additional unit-level data for ED boarding volumes and hours were included. Analyses were conducted at the hospital and unit levels where indicated.

Results: Patients with a discharge order by 9 am have longer mean hours from order to discharge than patients without a discharge order by 9 am (9.04 vs 2.48 hours, P < .001) ED boarding total (R2 = 46.2%, P ≤ .001), percentage (R2 = 50.4%, P ≤ .001), median minutes (R2 = 24.6%, P = .005), and total minutes (R2 = 40.8%, P ≤ .001) all increased as discharge by 11 am performance improved. The mean LOS is longer for the discharge by 11 am group than the non-discharge by 11 am group -1.67; 95% CI, -2.03 to -1.28, P < .001). Discharge by 11 am patients had a LOS/GMLOS ratio 21.9% higher than the non-discharge by 11 am cohort (difference -0.31; 95% CI, -0.36 to -0.26, P < .001).

Conclusions: Discharge order entry and release by 9 am and patient physically discharged by 11 am initiatives demonstrate a statistical increase in time from discharge order to discharge time, ED boarding, LOS, and observed-to-expected LOS.

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开错了方向：探索提前出院计划对住院时间的意外影响。

重要性：为缩短住院时间（LOS）、改善患者流量并减少急诊科（ED）的住院人数，提前让患者出院已成为急诊科的标准工作：对一家学术医疗中心从 2020 年 1 月 1 日至 2022 年 6 月 30 日上午 11 点前出院计划的结果进行回顾性分析。该分析探讨了上午 11 点前出院目标对患者从出院单签发到出院的时间、急诊科住院人数、LOS 以及观察到的预期 LOS 的影响：患者层面的电子病历数据包括出院单输入时间、出院时间、LOS 和诊断相关组几何 LOS（GMLOS）。此外，还包括急诊室住院人数和住院时间等单位层面的数据。在医院和科室层面（如有标明）进行了分析：上午 9 点前下达出院指令的患者从下达指令到出院的平均时间要长于上午 9 点前未下达出院指令的患者（9.04 小时 vs 2.48 小时，P < .001）。随着上午 11 点前出院情况的改善，急诊室登机总人数（R2 = 46.2%，P ≤ .001）、百分比（R2 = 50.4%，P ≤ .001）、中位数分钟数（R2 = 24.6%，P = .005）和总分钟数（R2 = 40.8%，P ≤ .001）均有所增加。上午 11 点前出院组的平均住院日长于非上午 11 点前出院组-1.67；95% CI，-2.03 至-1.28，P 结论：上午 11 点前出院组的平均住院日长于非上午 11 点前出院组：上午 9 点前输入出院指令并出院，以及上午 11 点前患者出院的举措表明，从出院指令到出院的时间、ED 登机时间、LOS 以及观察到的预期 LOS 均有统计学意义上的增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

1.90

自引率

8.30%

发文量

108

期刊介绍： Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.