Things We Do for No Reason™: Discharge before noon

CLINICAL SCENARIO

A hospital has recently implemented a goal of 30% of discharges before noon to address overcrowding and boarding in the emergency department (ED). To accommodate this, resident didactics were cut to 30 min and the hospital medicine team starts rounding at 8:30 a.m. On rounds, teams are encouraged to prioritize patients who are possible discharges to meet the administrative goal. The medical student, who is covering two of the more complex patients who are not ready for discharge and about whom she has several questions, worries that this change in priorities will negatively impact her patients by delaying their evaluation. She asks about this change in rounding structure and how inpatient discharges affect the ED.